绝经后女性患者行PVP术后继发相邻椎体骨折的危险因素分析

Risk factors of adjacent vertebral fractures after PVP in postmenopausal women

目的探讨绝经后女性骨质疏松性椎体压缩骨折(Osteoporotic vertebral compression fracture,OVCF)患者行PVP术后继发相邻椎体骨折(Adjacent vertebral fractures,AVF)的风险因素及其阈值。方法纳入2015年7月-2018年7月采用PVP治疗的61例绝经后女性OVCF患者。随访其术后1个月内的AVF发生情况,并作为AVF组;其余患者作为非AVF组。统计两组患者的年龄、身高、体重、体重指数(BMI)、L2-4椎体和髋部骨密度值、骨转换标志物水平[骨碱性磷酸酶(BAP)和I型胶原交联氨基末端肽(NTX)]等相关因素,进行组间对比,并进行Logistic回归分析,计算风险阈值。结果 61例中,14例术后1个月发生AVF,发生率为23.0%;其中,仅4例为下位椎体(28.57%),另10例为上位椎体(71.43%),提示上位椎体再发骨折的风险更高。AVF组年龄显著大于非AVF组(P=0.012),L2-4和髋部BMD值均显著低于非AVF组(P=0.001,P=0.000),NTX水平显著高于非AVF组(P=0.030);Logistic回归分析表明,年龄(OR=4.3)、L2-4(OR=8.1)和髋部BMD值(OR=9.3)是发生AVF的独立风险因素。经逐级风险阈值计算,年龄≤75岁、L2-4骨密度≥0.700 g/cm^2、髋部骨密度≥0.700 g/cm^2,是PVP术后早期并发AVF的低风险阈值。结论绝经后女性患者行PVP术后早期发生AVF与年龄偏高、L2-4和髋部骨密度值偏低有关;年龄<75岁、L2-4和髋部BMD≥0.700 g/cm^2的患者AVF风险更低。

Objective To investigate the risk factors and thresholds of secondary adjacent vertebral fractures (AVF) in postmenopausal women with osteoporotic vertebral compression fracture (OVCF) after PVP.Methods From July 2015 to July 2018,61 postmenopausal women with OVCF were treated with PVP in our hospital.The occurrence of AVF within 1 month after operation was counted and selected as AVF group,and the other patients were selected as non-AVF group.Age,height,weight,body mass index (BMI),bone mineral density (BMD) of L2-4 vertebral body and hip,bone turnover markers [bone alkaline phosphatase (BAP) and collagen type I cross-linked amino-terminal peptide (NTX) ] and other related factors in the two groups were analyzed and compared.Logistic regression analysis was carried out to calculate the risk threshold.Results Among the 61 cases,14 cases had AVF one month after operation,the incidence rate was 23.0%.Of them,only 4 cases had AVF in the lower vertebral body (28.57%) of the original operation,and the other 10 cases had AVF in the upper vertebral body (71.43%),suggested that the risk of recurrent fracture of the upper vertebral body was higher.In the inter-group comparison,the age of AVF group was significantly older than non-AVF group (P =0.012),L2-4 and hip BMD values were significantly lower than non-AVF group (P = 0.001,P = 0.000),NTX levels were significantly higher than non-AVF group (P = 0.030).Logistic regression analysis showed that age (OR = 4.3),L2-4 (OR= 8.1) and hip BMD (OR= 9.3) were independent risk factors for AVF.According to the step-by-step risk threshold calculation,age<75 years old,L2-4 BMD<0.700 g/cm^2,hip BMD<0.700 g/cm^2 were low risk thresholds for AVF in early stage after PVP.Conclusion The early occurrence of AVF in postmenopausal women after PVP is associated with older age,lower L2-4 and hip BMD,and lower AVF risk factors are patients with age<75,L2-4 and hip BMD < 0.700 g/cm^2.