经皮椎体成形术后非手术椎体再发骨折的危险因素分析

The risk factors analysis of vertebral fracture of non-surgical vertebral body after percutaneous vertebroplasty was performed

目的 分析经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗骨质疏松性椎体压缩性骨折(osteoporotic vertebral compression fracture,OVCF)后非手术椎体再发骨折的危险因素。方法回顾性分析2013年1月至2014年12月在本院脊柱外科因OVCF行PVP治疗的156例住院患者的病例资料,根据术后随访期间是否发生非手术椎体骨折分为骨折组(n=60)和非骨折组(n=96),并按照骨折部位将骨折组分为相邻椎体组(n=39)和非相邻椎体组(n=21)。比较各组患者年龄、性别、骨折椎体部位、骨密度、体重指数(body mass index,BMI)、椎体高度恢复率、骨水泥注入量、骨水泥椎间盘内渗漏等方面的差异,采用logistic回归法分析PVP术后非手术椎体再发骨折的危险因素。结果骨折组骨密度、BMI、椎体高度恢复率明显低于非骨折组(P<0.05),女性、骨水泥向椎间盘内渗漏、骨折椎体部位为胸腰段的比例明显高于非骨折组(P<0.05)。Logistic回归分析显示,年龄、骨折椎体部位(胸腰段)、骨密度、骨水泥向椎间盘内渗漏是PVP术后非手术椎体再发骨折的独立危险因素(P<0.05)。相邻椎体组骨密度明显低于非相邻椎体组,年龄、骨水泥向椎间盘内渗漏的比例明显高于非相邻椎体组(P<0.05)。Logistic回归分析显示,年龄、骨折椎体部位(胸腰段)、骨密度、骨水泥向椎间盘内渗漏是PVP术后相邻非手术椎体再发骨折的独立危险因素(P<0.05)。结论高龄、骨质疏松程度、骨折椎体部位(胸腰段)、骨水泥向椎间盘内渗漏是PVP术后非手术椎体再发骨折的独立危险因素。

Objective Analysis of the risk factors for non-surgical vertebral fracture after percutaneous vertebroplasty（PVP） in the treatment of osteoporotic vertebral compression fracture（OVCF）. Method 156 patients with osteoporotic vertebral compression fracture（OVCF）who were treated with PVP in Orthopedic Department of our hospital from January 2013 to December 2014 were selected. They were followed up and recorded new vertebral fractures conditions. they were divided into fracture group（n=60） and non-fracture group（n=96）according to whether fracture. New fracture patients were divided into adjacent fractures group（n=39） and non contiguous fracture group（n=21） according to whether adjacent fractures. Statistical analysis of patients age,gender, vertebralbodyfracturesite, bonemineraldensity（BMD）, body mass index（BMI）, vertebral body height recovery rate, bone cement injection, leakage of bone cement in the intervertebral disc conditions and other factors. The difference of influence factors among the groups was compared, and Logistic multifactor analysis was used to understand the independent risk factors. Result Bone mineral density（BMD）, body mass index（BMI）, vertebral height recovery rate were significantly lower than non-fracture group（P〈0.05）. Gender, the ratio of bone cement intradiscal leakage, fracture vertebral site（thoracolumbar） in fracture group was significantly higher than that of non-fracture group（P〈0.05）. The age of the patient, the fracture vertebral site（thoracolumbar）, bone mineral density and bone cement intervertebral disc leakage were the independent risk factors for postoperative fracture of PVP（P〈0.05）. The bone mineral density of the adjacent vertebral group was significantly lower than that in the non-adjacent vertebral group, and the age of the patient and the proportion of leakage in the bone cement disc was significantly higher than that in the non-adjacent vertebral fracture group（P〈0.05）. Age, fractural vertebral site（thoracolumbar）, bone mineral density,and bone cement intervertebral disc leakage were independent risk factors of adjacent non-surgical vertebral fracture after PVP（P〈0.05）.Conclusion The independent risk factor of postoperative fracture of PVP are the degree of aging, osteoporosis, surgical site（thoracolumbar）and bone cement intervertebral disc leakage.