假定骨質疏鬆性椎體壓迫性骨折經皮椎體成形術或椎體整形術意外發現惡性腫瘤的機率

Incidence of unexpected malignancy in presumed osteoporotic vertebral compression fractures undergoing percutaneous vertebroplasty or kyphoplasty

簡介：椎體壓迫性骨折是骨質疏鬆症中最常見的骨折。經皮椎體成形手術和椎體整形手術是可以有效減少背部疼痛，恢復身高和改善生活品質的手術方式。然而，非骨質疏鬆症病因的椎體壓迫性骨折，包括意外的惡性腫瘤，有時難以在術前區分。本研究目的在調查假定骨質疏鬆性椎體壓迫性骨折經皮椎體成形術或椎體整形術意外發現惡性腫瘤的發生率。方法：回顧性分析2010 年12 月至2017 年8 月共127 例假定骨質疏鬆性椎體壓迫性骨折患者接受經皮椎體成形手術或椎體整形手術治療的患者。收集基本資料，手術方法，磁共振圖像，病理報告。計算椎體組織切片檢查結果中意外惡性腫瘤的發生率。結果：共檢查了來自127 名接受37 個經皮椎體成形手術和96個經皮椎體整形手術患者的161 個椎體組織切片結果。由此，通過病理學檢查意外發現兩個多發性骨髓瘤和一個轉移性脂肪肉瘤。意外發現惡性腫瘤的發生率為2.4％（3/127）。結論：在假定骨質疏鬆性椎體壓迫性骨折中要排除非骨質疏鬆症病因，特別是惡性腫瘤，我們建議在經皮椎體成形手術和椎體整形手術中應進行椎體組織切片檢查。

 

Background and purpose: Vertebral compression fractures (VCFs) are the most common fracture caused by osteoporosis. Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) are effective surgical interventions for reducing back pain, restoring body height, and improving quality of life. However, VCFs with nonosteoporotic etiologies, including unexpected malignancy, are sometimes difficult to distinguish preoperatively. This study investigated the incidence of unexpected malignancy in presumed osteoporotic VCFs undergoing PVP or PKP. Methods: A total of 127 patients with presumed osteoporotic VCFs undergoing PVP or PKP from December 2010 to August 2017 were retrospectively enrolled. Demographics, surgical method, magnetic resonance images, pathological report were collected. The incidence of unexpected malignancy in biopsy results was calculated. Results: A total of 161 vertebral biopsies from 127 patients undergoing 37 PVPs and 96 PKPs were examined. From these, two multiple myelomas and one metastatic liposarcoma were revealed through pathological examination. The incidence of unexpected malignancy was 2.4% (3/127). Conclusion: A biopsy is advisable during PVP and PKP in cases of presumed osteoporotic VCFs to exclude nonosteoporotic etiologies, specifically malignancy.