目的 探讨老年胸腰椎骨质疏松性压缩骨折接受经皮穿刺椎体成形术(percutane-ous vertebroplasty,PVP)术后继发椎体再骨折的危险因素.方法 2015年1月1日～2020年12月31日于我院行单节段PVP手术治疗胸腰椎椎体压缩性骨折病人1 258例次,收集病人性别、年龄、体质指数(body mass index,BMI)、骨密度T值、手术穿刺入路、骨水泥注射量、骨水泥弥散状态、骨水泥渗漏情况、椎体高度恢复、后凸角度恢复、椎体楔形变角度恢复、术后抗骨质疏松药物应用等影像及临床资料,采用单因素及多因素Logistic回归分析,对比这些参数在再骨折组与无再骨折组人群中的差异,评价这些因素与术后椎体再骨折的相关性.结果 247例病人发生再骨折49例(3.90％).单因素分析结果显示,骨折后凸角较大、存在椎体裂隙征、伴有终板破坏、骨水泥注射量较小、骨水泥与终板存在不接触、椎体复位率较大是PVP术后椎体再骨折的危险因素.将这些因素进行多因素Logistic回归分析结果显示,较大的骨水泥注射量(OR=0.37,95％CI:0.19～0.55,P=0.018)是PVP术后椎体再骨折的保护性因素,术前伴有终板破坏(OR=2.86,95％CI:1.14～7.53,P=0.026)、术前伴有椎体裂隙征(OR=18.15,95％CI:3.07～44.79,P=0.003)、较大的椎体复位率(OR=3.58,95％CI:1.38～8.40,P=0.007)、伴有骨水泥与终板接触不佳(OR=3.01,95％CI:1.92～10.65,P=0.004)是PVP术后椎体再骨折的独立危险因素.结论 骨水泥注射量较小、术前骨折椎体伴有终板破坏、伴有椎体裂隙征、较大的椎体复位率、伴有骨水泥与终板接触不佳是采用PVP治疗老年胸腰椎骨质疏松性压缩骨折术后出现再骨折的独立危险因素.
Analysis of the incidence and risk factors of postoperative refractures in elderly patients with thoracolumbar vertebral osteoporotic compression fractures after PVP
Objective To investigate the risk factors of postoperative vertebral body refracture after percutaneous vertebroplasty(PVP)in the treatment of thoracolumbar osteoporotic compression fracture.Methods The radiological and clinical data of 1258 patients who underwent single-level PVP surgery for thoracolumbar vertebral compression fracture in our hospital from January 1,2015 to December 31,2020 were retrospectively analyzed.Gender,age,body mass index(BMI),bone mineral density(BMD),surgical approach,injection amount of cement,diffusion state of,leakage,vertebral height restores,kyphotic angle reduction,wedge angle reduction of vertebral body,postoperative anti-osteoporosis drug application and other radiological and clinical data of patients were collected and analyzed by univariate and multivariate analysis.The differences of these parameters in the refracture group and the non-refracture group were compared to evaluate the correlation between these factors and postoperative vertebral refracture.Results A total of 247 patients were included in this study.The incidence of refracture was 3.90％in 49 patients.Univariate analysis showed that large kyphotic angle,intravertebral cleft sign,endplate cortical disruption,small injection amount of bone cement,non-contact between bone cement and endplate,and high reduction rate of vertebral body were risk factors for vertebral refracture after PVP.Multivariate analysis of these factors showed that large injection amount of bone cement(OR=0.37,95％CI:0.19-0.55,P=0.018)was a protective factor for vertebral refracture after PVP,and preoperative endplate cortical disruption(OR=2.86,95％CI:1.14-7.53,P=0.026),preoperative intravertebral cleft sign(OR=18.15,95％CI:3.07-44.79,P=0.003),large vertebral reduction rate(OR=3.58,95％CI:1.38-8.40,P=0.007),and poor contact between bone cement and endplate(OR=3.01,95％CI:1.92-10.65,P=0.004)were independent risk factors for vertebral refracture after PVP.Conclusion In this study,it was found that small injection amount of bone cement,endplate cortical disruption before surgery,intravertebral cleft sign,large vertebral reduction rate,and poor contact between bone cement and endplate were independent risk factors for postoperative refracture after PVP treatment of osteoporotic compression fractures in the elderly thoracolumbar spine.
万方数据
维普
