PKP术后新发椎体骨折危险因素分析

Risk factors of new vertebral fractures after percutaneous kyphoplasty

目的:探讨经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松压缩骨折(osteoporosis vertebral compression fracture,OVCF)术后新发椎体骨折的危险因素。方法:回顾性分析2011年7月至2013年7月我科采用PKP治疗的86例OVCF患者,根据是否有非手术椎体新发骨折分为新发骨折组(A组)及未骨折组(B组)。采用t检验、方差分析、logistic回归分析新发椎体骨折的危险因素:年龄、性别、骨密度(bone mineral density,BMD)、骨水泥注入量、骨折椎体压缩程度、骨水泥椎间盘漏、骨折椎体数量。结果:21例患者(24.4%)新发骨折,15例发生在术后3个月内,6例发生在3个月后,16例为邻近椎体骨折,5例为非邻近椎体骨折;A组BMD(-3.43±0.42)低于B组(-2.91±0.20)(P=0.000);A组骨水泥椎间盘漏发生率大于B组(P=0.031);A组术前多椎体骨折发生率(≥2个)大于B组(P=0.000)。2组患者的年龄(P=0.453)、性别(P=0.841)、骨水泥注入量(P=0.081)、骨折椎体压缩程度无差别(P=0.717)。logistic回归分析结果:骨密度OR=36 277.255、95%CI=60.057~21 913 095.13、P=0.001,术前存在2个及2个以上椎体骨折OR=13.275、95%CI=1.746~100.938、P=0.012,术中骨水泥发生椎间盘漏OR=26.785、95%CI=1.355~529.551、P=0.031。结论:骨密度低、术前存在2个及2个以上椎体骨折、术中骨水泥发生椎间盘漏是PKP术后新发椎体骨折的危险因素。

Objective：To investigate the risk factors of new fracture after percutaneous kyphoplasty（PKP）in the treatment of osteoporosis vertebral compression fracture（OVCF）. Methods：Clinical data of 86 patients with OVCF who were treated with PKP from July2011 to July 2013 in our department were retrospectively analyzed. The following characteristics were compared in patients with new VCFs（group A）after PKP versus patients without new VCFs（group B）：patient age,sex,bone mineral density,number of preexisting VCFs,grade of VCFs,volume of injected cement,and cement leakage in intervertebral disc spaces. T test,analysis of variance,and logistic regression analysis were used for statistical analysis. Results：Twenty-one（24.4%）of 86 patients had new VCFs during 1 year of follow-up after PKP. Fifteen cases of new VCFs occurred within 3 months of PKP;sixteen cases of new VCFs appeared in levels adjacent to treated levels,while the other five cases not. BMD of group A（-3.43±0.42）was lower than that of group B（-2.91±0.20）（P=0.000）. The incidence of cement leakage to intervertebral disc of group A was higher than that of group B（P=0.031）. Incidence of multi-level vertebral fractures was higher in group A than in group B（P =0.000）. There was no difference in patient＇s age（P =0.453）,gender（P=0.841）,bone cement injection（P=0.081）,degree of vertebral body compression between two groups（P=0.717）. Logistic regression analysis results indicated lower bone mineral density（OR=36 277.255,95%CI=60.057 to 21 913 095.13,P=0.001）,more than two preexisting VCFs（OR=13.275,95%CI=1.746 to 100.938,P=0.012）,and cement leakage to adjacent intervertebral disc（OR=26.785,95%CI=1.355 to 529.551,P=0.031）. Conclusion：Lower bone mineral density,more than two preexisting VCFs and cement leakage to adjacent intervertebral disc are the risk factors for the development of new VCF.