The impact of paravertebral muscle degeneration on postoperative recurrence of adjacent vertebral fractures in OVCF pa-tients:based on rigorous propensity matching analysis
The impact of paravertebral muscle degeneration on postoperative recurrence of adjacent vertebral fractures in OVCF pa-tients:based on rigorous propensity matching analysis
Objective To demonstrate the correlation between paravertebral muscle degeneration and recurrent adjacent vertebral fractures(AVF)in patients with osteoporotic vertebral compression fractures(OVCF)after PKP using a rigorous propensity matching analysis method.Method Forty OVCF patients who underwent PKP surgery in our hospital from January 2019 to January 2022 and expe-rienced recurrent AVF within one year after surgery were selected as the study subjects and included in the AVF group;At the same time,a strict propensity matching analysis method was used to randomly match 40 OVCF patients who underwent PKP surgery at the same time and did not experience AVF within 1 year after surgery in a 1∶1 ratio based on age,gender,body mass index,and OVCF fracture site in the AVF group as the control group.All patients underwent lumbar MRI examination before surgery,with the scanning plane parallel to the vertebral endplate.The cross-sectional area(CSA)and functional cross-sectional area(FCSA)of the psoas ma-jor,erector spinalis,multifidus,and paraspinal muscles were measured at the lower endplate planes of the L3 and L4 vertebral bodies,respectively;In addition,preoperative vertebral bone density and kyphosis angle(KA),as well as the ratio of anterior and posterior vertebral walls(AP),were measured in patients.The above indicators were compared between the two groups of patients,and the CSA and FCSA of the erector spinae,multifidus and psoas major muscles measured at the L3 level and L4 level of MRI examination in the patients in the AVF group were compared using Delong's test,so that the relevant indicators with potential predictive value of AVF were derived through ROC curve analysis;the indicators were subjected to multivariate regression analysis through the Logistic regression model to verify the independent effect of paravertebral mus-cle degeneration on AVF.Results The CSA and FCSA values of the multifidus,erector spinalis,psoas major,and paraspinal mus-cles at L3 and L4 levels in the AVF group were significantly lower than those in the control group(P＜0.05).Delong test and ROC curve analysis showed that the L4 level of paravertebral muscle FCSA was a potential predictive indicator of AVF.The KA angle of the AVF group was significantly higher than that of the control group,and the bone density value was significantly lower than that of the control group(P＜0.05);There was no statistically significant difference in the AP value,bone cement leakage,and comorbidities between the two groups of patients(P＞0.05).Logistic regression model analysis showed that bone density values(β=-0.069;OR=0.915)and L4 level paravertebral muscle FCSA(β ＝-0.263;OR=0.816),both were independent risk factors for AVF in OVCF patients undergoing PKP surgery.Conclusion Paravertebral muscle degeneration is an independent predictor of postoperative AVF af-ter PKP,and patients with OVCF should not only be emphasized on regular long-term anti-osteoporosis treatment,but also be encour-aged to undergo paraspinal muscle functional training,which can help reduce the risk of postoperative AVF.
维普
万方数据