延伸至终板的骨折线对PVP术后同一椎体再发骨折的预测价值

Predictive Value of Endplate Cortical Disrupture for Recurrent Fracture of the Same Vertebral Body after PVP

目的探讨经皮椎体成形术(PVP)手术且存在骨水泥-终板未接触(NPEC)的患者延伸至终板骨折线在预测PVP术后同一椎体再发骨折的价值。方法回顾性分析收治的OVCF并进行PVP手术的患者123例,其中男性40例,女性83例,年龄68~90岁,平均年龄79.92岁,根据同一椎体是否再发骨折进行分组,即分为复发组(再发椎体骨折)和非复发组(非再发椎体骨折)。并将患者性别、年龄、骨折水平、延伸至终板的骨折线、椎体楔形角度、骨水泥外渗、骨水泥体积作为自变量,采用单因素及多因素回归分析再发骨折的危险因素。结果复发组40例,其中男性24例,女性16例,年龄70~89岁,平均年龄78.67岁;非复发组83例,其中男性40例,女性43例,年龄68~90岁,平均年龄76.92岁。Logistic单因素分析显示存在骨水泥-终板未接触时,延伸至终板的骨折线与再发骨折相关(χ^2=9.799,P=0.002);多因素Logistic回归分析显示存在骨水泥-终板未接触时,延伸至终板的骨折线为再发骨折的独立危险因素(OR=3.461,P=0.009)。结论存在骨水泥-终板未接触时,延伸至终板的骨折线出现预示着PVP术后再发骨折的风险增高。

Objective To explore the value of endplate cortical disrupture in patients with osteoporotic vertebral compression fractures(OVCF) and non-PMMA-endplate-contact(NPEC) in predicting the same vertebral fracture after PVP. Methods A retrospective analysis of patients who underwent OVCF from January 2014 to May 2018 and underwent PVP surgery was performed to select eligible patients, including 40 patients with recurrent vertebral fractures and 83 patients with non-recurrent vertebral fractures. Gender, age, fracture level, endplate cortical disrupture, vertebral wedge angle, bone cement extravasation, and bone cement volume were used as independent variables. Single factor and multivariate regression analysis were used to analyze the risk factors of recurrent fracture. Results There were 40 patients in the recurrence group, including 24 males and 16 females, aged 70~89 years, with an average age of 78.67 years;83 patients in the nonrecurrent group, including 40 males and 43 females, aged 68~90 years, with an average age of 76.92 years.Logistic univariate analysis showed that endplate cortical disrupture(χ^2=9.799, P=0.002) was associated with recurrent fracture in the absence of NPEC;multivariate logistic regression analysis showed the presence of NPEC, endplate cortical disrupture(OR=3.461, P= 0.009) was an independent risk factor for recurrent fracture. Conclusion In the presence of NPEC, the fracture line extending to the endplate indicates an increased risk of re-fracture after PVP.