摘要
目的 探讨定量CT骨性影像学参数和骨密度(bone mineral density,BMD)对胸腰椎骨折患者经皮椎体成形术(percutaneous vertebroplasty,PVP)术后继发骨折的预测效能.方法 选取 2020 年 1 月—2022 年 12 月收治的胸腰椎骨折135 例,根据术后1 年是否继发椎体再骨折分为继发组27 例和未继发组 108 例.比较 2 组基线资料、术前定量CT骨性影像学参数、BMD,分析各参数与BMD对PVP术后继发骨折的预测效能.结果 继发组年龄大于未继发组,骨水泥渗漏发生率高于未继发组(P＜0.05);继发组定量CT骨性影像学参数大于未继发组,BMD小于未继发组(P＜0.01).椎体压缩率、椎体楔变角、局部后凸角、棘突间距增加值、椎弓根间距增加值与BMD呈负相关(r=-0.688、-0.463、-0.519、-0.481、-0.504,P＜0.001).椎体压缩率、椎体楔变角、局部后凸角、棘突间距增加值、椎弓根间距增加值、BMD预测胸腰椎骨折患者PVP术后继发骨折的曲线下面积(AUC)分别为 0.761、0.833、0.808、0.847、0.814、0.782.椎体压缩率、椎体楔变角、局部后凸角、棘突间距增加值、椎弓根间距增加值高水平的胸腰椎骨折患者PVP术后继发骨折风险是低水平患者的5.445、15.164、5.105、7.722、8.800 倍;BMD低水平的胸腰椎骨折患者PVP术后继发骨折风险是高水平患者的 6.214 倍.定量CT骨性影像学参数与BMD联合预测胸腰椎骨折患者PVP术后继发骨折的AUC大于各参数及BMD单独预测,敏感度为92.59%,特异度为76.85%.结论 定量CT骨性影像学参数联合BMD对于胸腰椎骨折患者PVP术后继发骨折具有较高预测价值,可为临床早期预测术后继发骨折风险提供参考依据.
Abstract
Objective To investigate the efficacy of quantitative CT bone imaging parameters and bone mineral densi-ty(BMD)in predicting secondary fractures in thoracolumbar fracture patients after percutaneous vertebroplasty(PVP).Methods A total of 135 patients with thoracolumbar fracture treated from January 2020 to December 2022 were selected and divided into the secondary group(n=27)and the non-secondary group(n=108)according to whether there was secondary vertebral refracture at 1 year after surgery.Baseline data,preoperative quantitative CT bone imaging parameters and BMD were compared between the two groups,and the predictive efficacy of each parameter and BMD on secondary fractures after PVP was analyzed.Results The age of the secondary group was higher than that of the non-secondary group,and the inci-dence of bone cement leakage was higher than that of the non-secondary group(P＜0.05).CT bone imaging parameters in the secondary group were higher than those in the non-secondary group,while BMD was lower than that in the non-secondary group(P＜0.01).Vertebral compression rate,vertebral wedge angle,local kyphotic angle,increased spinous process dis-tance,and increased pedicle distance were negatively correlated with BMD(r=-0.688,-0.463,-0.519,-0.481,-0.504,P＜0.001).The area under the receiver operating characteristic(AUC)curve(AUC)of vertebral compression ra-tio,vertebral wedge angle,local kyphotic angle,increased spinous process distance,increased pedicle distance and BMD for predicting secondary fractures after PVP in patients with thoracolumbar fracture was 0.761,0.833,0.808,0.847,0.814 and 0.782,respectively.The risk of secondary fracture after PVP was 5.445,15.164,5.105,7.722,and 8.800 times higher in thoracolumbar fracture patients with high level of vertebral compression rate,vertebral wedge angle,local kyphotic angle,in-creased spinous process distance,and increased pedicular distance than in patients with low level.The risk of secondary frac-ture after PVP in patients with low BMD was 6.214 times higher than that in patients with high BMD.The AUC of combined quantitative CT bone imaging parameters and BMD for predicting secondary fracture AUC after PVP in patients with thoraco-lumbar fracture was greater than that predicted by each parameter and BMD alone,with a sensitivity of 92.59%and a speci-ficity of 76.85%.Conclusion Quantitative CT bone imaging parameters combined with BMD have high predictive value for secondary fractures after PVP in patients with thoracolumbar fractures,and can provide a reference for early clinical prediction of the risk of secondary fractures after PVP.
维普
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