The Effect of Cement Distribution on Adjacent Vertebral Body Re-Fracture After PKP and Analysis of Related Risk Factors
Objective To assess the impact of cement distribution following percutaneous kyphoplasty(PKP)on the occurrence of adjacent vertebral body re-fracture and to identify associated risk factors.Methods A retrospective study was conducted on 112 patients with single-segment osteoporotic vertebral compression fractures(OVCF)treated with PKP between August 2021 and May 2023.The patients were categorized into two groups:Recurrent fracture group and non-fracture group,based on the occurrence of re-fracture.The recurrent fracture group comprised 20 patients(6 males and 14 females)with a mean age of(77.50±7.34)years.Of these,12 fractures occurred in the thoracic segment and 8 in the lumbar segment.The non-fracture group included 92 patients(24 males and 68 females)with a mean age of(72.59±8.29)years,with 43 fractures in the thoracic segment and 49 in the lumbar segment.Clinical data were collected and analyzed using t-test and X2 test.Logistic regression analysis was employed to identify risk factors for recurrent fracture.The predictive capability of risk factors and cement distribution for postoperative recurrent fracture was evaluated using receiver operating characteristic(ROC)curves and the area under the curve(AUC).Results The patients in both groups were followed up for 12 to 17 months,with a mean follow-up of(13.05±0.89)months in the re-fractured group and(12.33±2.20)months in the unfractured group.The incidence of recurrent fracture of adjacent vertebrae after PKP was 17.86％.Recurrent fractures occurred at a mean of(27.00±12.33)weeks after the initial PKP procedure.Statistical analysis revealed significant differences between the recurrent fracture and non-fracture groups in terms of age,recovery rate of the anterior vertebral body height,postoperative anti-osteoporosis treatment,bone cement distribution patterns,cement leakage,and recovery rate of the anterior vertebral body height(P＜0.05).Logistic regression analysis identified bone cement distribution patterns,absence of postoperative anti-osteoporosis treatment,and cement leakage as independent predictors of recurrent fracture following PKP(P＜0.05).Among the cement distribution patterns,type Ⅰ exhibited a higher risk of postoperative recurrent fracture compared to types Ⅱ to Ⅴ(OR=12.764,P＜0.05).The predictive value of cement distribution typing for recurrent fracture after PKP was evaluated,revealing an area under the curve(AUG)of 0.277,with a sensitivity of 5.00％and a specificity of 72.80％.Conclusion Bone cement distribution type 1 has a higher risk of recurrent fracture compared to other distribution patterns.Bone cement dispersion patterns,lack of postoperative osteoporosis treatment,and cement leakage are all risk factors for recurrent fractures after PKP.
bone cement distributionrecurrent fracturepercutaneous vertebral kyphoplasty
万方数据
维普
