椎体后凸成形术治疗骨质疏松性椎体压缩骨折后加固椎体再压缩危险因素分析

Risk factors of vertebral recompression after kyphoplasty for osteoporotic vertebral compression fracture

目的探讨椎体后凸成形术治疗骨质疏松性椎体压缩骨折后加固椎体发生再压缩的危险因素。方法回顾性分析2012年1月至2014年1月,我院收治的单节段骨质疏松性椎体压缩骨折并接受椎体后凸成形术患者共252例,根据患者随访影像学资料,将所有患者分为无压缩对照组和再压缩组,应用单因素和多因素分析研究导致椎体再压缩的可能因素,如年龄、性别、体质指数、是否为新鲜骨折、术前是否存在其它合并症、既往是否发生其它椎体压缩骨折、是否发生骨水泥渗漏、术前骨密度T值、注射骨水泥量、术前椎体压缩率、术后椎体压缩率、骨水泥是否与上下终板均接触、伤椎是否发生椎体内裂隙,推测其中可能导致术后加固椎体再压缩的危险因素。结果术后发生再压缩45例,未再压缩者207例,压缩组术前合并其它合并症40例,未再压缩组141例;压缩组平均术前骨密度T值(-2.89±0.32),未再压缩组(-2.64±0.29);压缩组骨水泥与上下终板均接触者13例,未再压缩组141例;压缩组骨水泥发生椎体内裂隙者19例,未再压缩组44例。单因素分析结果表明,术前存在其它合并症、术前骨密度T值、骨水泥与上下终板均接触在两组之间差异有统计学意义。多因素Logistic回归分析显示术前存在其它合并症(OR=0.223)和术前骨密度T值低(OR=0.053)是危险因素,骨水泥与上下终板均接触(OR=6.296)是保护因素。结论术前存在其它合并症和患者骨密度过低是椎体后凸成形术后加固椎体再压缩的重要危险因素,对有存在以上两种情况的患者进行密切观察随访十分重要。

Objective To investigate the risk factors of vertebral recompression after percutaneous kyphoplasty in the patients with osteoporotic vertebral compression fractures. Methods The clinical data of 252 patients with osteoporotic vertebral compression fractures who underwent single-level percutaneous kyphoplasty in our hospital from January 2012 to January 2014 were retrospectively reviewed. All the patients were divided into recompression group and non-recompression group according to the radiological data collected during the follow-up. Thirteen potential factors of vertebral recompression were assessed using univariate and multivariate analyses, including age, gender, body mass index, fresh fracture or not, other comorbidities or not, previous vertebral compression fracture or not, cement leakage or not, preoperative bone mineral density T-score, volume of polymethylmethacrylate injected, preoperative and postoperative vertebral compression rate, polymethylmethacrylate-endplates contact or not and intravertebral cleft or not. Results After the surgery, 45 patients experienced recompression of cemented vertebrae, and 207 patients ont. There were 40 patients with other preoperative comorbidities in recompression group, and 141 in non-recompression group. The mean preoperative bone mineral density T-scores were （ -2.89 ± 0.32 ） and （ -2.64 ± 0.29 ） in recompression group and non-recompression group respectively. There were 13 and 141 patients with polymethylmethacrylate-endplates contact in recompression group and non-recompression group respectively. There were 19 patients with intravertebral cleft in recompression group, and 44 in non-recompression group. Other preoperative comorbidities, preoperative bone mineral density T-score and polymethylmethacrylate-endplates contact showed statistically significant differences between the 2 groups by the univariate analysis. And the multivariate logistic regression analysis indicated that combining with other comorbidities （ OR = 0.223 ） and low preoperative T-score （ OR = 0.053 ） were independent risk factors. However, the polymethylmethacrylate-endplates contact （ OR =6.296 ） was a protective factor. Conclusions Combined comorbidities and low preoperative bone mineral density T-score are 2 important risk factors of recompression of cemented vertebrae after percutaneous kyphoplasty, and a careful follow-up is necessary for the patients with these factors.