骨质疏松性胸腰椎压缩性骨折PKP术后再骨折危险因素分析

Analysis of risk factors of the re-fracture of osteoporotic thoracolumbar compression fractures after PKP

目的:探讨骨质疏松性胸腰椎压缩性骨折球囊扩张椎体后凸成形术(PKP)术后再骨折的相关危险因素。方法:回顾分析84例PKP术治疗的胸腰椎骨质疏松性压缩性骨折病人的临床资料,术后均获随访12~57个月;根据病人随访期间是否发生再骨折,将病人分为再骨折组和未再骨折组,对2组病人的性别、年龄、体质量指数、骨密度、损伤节段数量、术前陈旧性楔形变椎体率及受累椎体数、骨水泥注入方式、骨水泥注射量、术后有无椎间盘骨水泥渗漏、椎体前缘高度恢复率、术后后凸畸形角度和胸腰椎结构类型进行对比分析。结果:84例病人术后再骨折13例(18例次)。单因素分析显示,PKP再骨折组体质量指数、骨密度均低于未再骨折组(P<0.01),术前陈旧性椎体楔形变率、术后胸腰椎结构异常率高于未再骨折组(P<0.05)。logistic回归分析显示,体质量指数低、骨密度低、术前有陈旧性椎体楔形变及胸腰椎结构异常是PKP术后再骨折的危险因素(P<0.05~P<0.01)。结论:骨质疏松和胸腰椎结构的损伤程度是诱发骨质疏松性胸腰椎压缩性骨折PKP术后再骨折的危险因素。

Objective:To explore the risk factors of the refracture of osteoporotic thoracolumbar compression fractures after percutaneous kyphoplasty(PKP).Methods:The clinical data of 84 osteoporotic thoracolumbar compression fractures patients treated with PKP were retrospectively analyzed.All patients were followed up for 12 to 57 months.The patients were divided into the refracture group and non-refracture group according to the refracture condition.The gender,age,body mass index(BMI),bone mineral density(BMD),number of injured vertebrae,number of cases with wedge-shaped vertebral bodies,number of involved vertebrae,way of bone cement injection,bone cement injection volume,intervertebral disc leakage of bone cement,anterior vertebral height restoration,postoperative kyphosis and structural type of thoracolumbar vertebrae were compared between two groups.Results:Among 84 patients,the postoperative secondary fracture in 13 cases(18 times)after PKP were found.The results of univariate analysis showed the BMI and BMD in refracture group were lower than those in non-refracture group(P<0.01),and the postoperative thoracolumbar structural abnormality rate in refracture group were higher than those in non-refracture group(P<0.05).The results of logistic regression analysis showed that the body mass index,bone mineral density,preoperative old vertebral wedge-shaped change and postoperative thoracolumbar structural abnormality rate were the high risk factors of postoperative vertebral refracture.Conclusions:The osteoporosis and degree of thoracolumbar structural injury are the risk factors of osteoporotic thoracolumbar compression fracture after PKP.