激素诱导骨质疏松性胸腰椎体骨折PVP后再发骨折分析

Analysis on bone refracture in patients with hormone induced osteoporotic thoracolumbar vertebral fractures treated with PVP

目的探讨激素诱导骨质疏松性胸腰椎体骨折患者行经皮椎体成形术(PVP)后再发骨折的危险因素。方法选取2010年4月至2015年7月解放军第425中心医院收治的骨质疏松性胸腰椎体骨折患者646例,根据骨折类型分为原发性骨质疏松性胸腰椎体骨折(n=542)和激素诱导骨质疏松性胸腰椎体骨折(n=104),比较两组患者的再发骨折发生率。根据再发骨折发生情况将激素诱导骨质疏松性胸腰椎体骨折患者分为骨折组和无骨折组,对两组患者的临床资料进行单因素和多因素Logistic回归分析。结果原发性骨质疏松性胸腰椎体骨折患者再发骨折102例(18.82%),激素诱导骨质疏松性胸腰椎骨折患者再发骨折53例(50.96%)。骨折组和无骨折组患者的体质量指数、骨密度、骨水泥渗漏、术前椎体裂隙样变、未接受抗骨质疏松治疗比例差异有统计学意义(P<0.05)。骨密度、骨水泥渗漏、术前椎体裂隙样变、未接受抗骨质疏松治疗是影响激素诱导骨质疏松性胸腰椎体骨折患者行PVP后再发骨折的独立危险因素(P<0.05)。结论激素诱导骨质疏松性胸腰椎体骨折患者再发骨折风险较高,骨密度、骨水泥渗漏、术前椎体裂隙样变、是否接受抗骨质疏松治疗等是再发骨折的主要危险因素。

Objective To investigate the refracture and risk factors after percutaneous vertebroplasty （PVP） in the patients with hormone induced osteoporotic thoracolumbar vertebral fracture. Methods A total of 646 patients with osteoporotic thoracolumbar vertebral fractures in 425 Central Hospital of PLA from April 2010 to July 2015 were selected and divided into the primary osteoporotic thoracolumbar vertebral fractures （n= 542） and hormone-induced osteoporotic thoracolumbar vertebral fractures （n =104） according to the fracture types. The incidence rate of refracture was compared between the two types of patients. The patients with hormone induced osteoporotic thoracolumbar fractures were divided into the fracture group and non-fracture group according to the refracture occurrence situation. The clinical data of the two groups were performed the univariate and multivariate Logistic regression analysis. Results There were 542 cases of primary osteoporosis, 102 cases had refracture with the incidence rate of 18.82 %, 104 cases had hormone induced osteoporosis and 53 cases had refracture with the incidence rate of 50.96% . BMI, bone mineral density,bone cement leakage, preoperative vertebral fissure change and proportion of unreceiving anti-osteoporosis treatment had statistical difference between the fracture group and non-fracture group （P〈0.05）. Bone mineral density, bone cement leakage, preoperative vertebral fissure change and no anti-osteoporosis treatment were the independent risk factors for refracture after PVP operation in the patients with steroid-induced thoracolumbar vertebral fracture （P〈0.05）. Conclusion The patients with hormone induced osteoporotic thoracolumbar vertebral fracture have higher risk of refracture. Bone mineral density,hone cement leakage, preoperative vertebral fissure change, whether accepting anti-osteoporosis treatment are the major risk factors of refracture.