经皮椎体成形术后非手术椎体骨折的相关危险因素

The risk factors of onset of osteoporotic vertebral compression fractures after percutaneous vertebroplasty

目的：探讨骨质疏松椎体压缩性骨折（OVCFs）经皮椎体成形术（PVP）后非手术椎体骨折的相关危险因素。方法：对2010年3月。2013年3月收治的76例因OVCFs行PVP患者的临床资料进行回顾性分析，包括患者的一般情况、个人史及既往病史、腰椎骨密度、术中骨水泥注入量、病椎压缩程度、骨折椎体个数及节段、骨水泥椎间盘渗漏情况、术后抗骨质疏松治疗情况；收集患者术后第1、3、6、12、18个月来院复诊时测定的骨代谢相关生化指标数据，包括：血钙、磷、降钙素、I型胶原氨基端前肽、甲状旁腺激素、25-羟维生素D[25-（OH）D]。将上述指标作为可能相关因素纳入单因素研究，并通过多因素Logistic回归分析得出术后非手术椎体骨折的相关危险因素。结果：76例原发性OVCFs患者共89节椎体骨折，术后共17例患者19个椎体出现压缩性骨折，单因素分析显示术中骨水泥注入量、骨水泥椎间盘渗漏、术后有无抗骨质疏松治疗、血25-（OH）D水平与术后非手术椎体骨折存在显著相关性（P〈0．05）．而与患者性别、年龄、体重指数、骨密度值、病椎压缩程度、手术入路等无显著相关性（P〉0．05）。多因素分析结果显示骨水泥椎间盘渗漏、术后未进行抗骨质疏松治疗、25-（OH）D水平较低是PVP术后非手术椎体骨折的危险因素（P〈O．05）。结论：OCVFs患者PVP术后发生非手术椎体骨折与骨水泥渗漏至椎间盘、术后未抗骨质疏松治疗及低25-（0H）D水平有关。

Objectives： To explore the risk factors associated with the onset of vertebral compression frac- tures after percutaneous vertebroplasty（PVP）. Methods： A total of 76 patients undergoing PVP due to osteo- porotic vertebral compression fractures（OVCFs） from March 2010 to March 2013 was retrospectively analyzed, the data included age, body mass index, bone mineral density, number of initial vertebral fractures, bone ce- ment leakage into discs, use of antiosteoporotic medications. And the data of their bone metabolistie markers and 25-（OH）D levels of different periods after PVP were also assessed. Results： 17 patients experienced 19 subsequent fractures. Univariate analysis showed that bone cement injection volume, bone cement leakage into discs, use of antiosteoporotic medications and levels of 25-（OH）D were the variables associated with the onset of vertebral fractures（P〈0.05）. In contrast, age, sex, operation approach, body mass index and bone mineral density showed no significant differences. Muhiple-factors logistic regression analysis showed that bone cement leakage into discs, lower level of 25-（OH）D and absence of antiosteoporotie medication were the predominant correlative factors associated with the onset of vertebral fracture. Conclusions： The most important risk factors associated with onset of OVCFs are absence of antiosteoporotie medication and bone cement leakage into discs and low serum 25-（OH）D level.