骨质疏松性椎体压缩骨折经皮椎体成形术术后邻近椎体骨折的危险因素

Risk factors of adjacent vertebral fractures after percutaneous vertebroplasty for osteoporotic vertebral compression fracture

目的探讨骨质疏松性椎体压缩骨折经皮椎体成形术(PVP)术后发生邻近椎体骨折的相关危险因素。方法267例接受PVP治疗的骨质疏松性椎体压缩骨折患者根据术后邻近椎体是否骨折分为无再骨折组(219例)和再骨折组(48例)。记录患者的年龄、性别、身高、体重、骨密度、骨水泥注入量、骨水泥渗漏、骨水泥分布(致密型、弥散型)、椎体高度恢复率、术后是否使用抗骨质疏松药等。采用单因素、多因素logistic回归分析术后邻近椎体骨折的高危独立因素。结果两组患者在年龄、性别、体重指数、骨密度、骨水泥注入量、骨水泥渗漏、骨水泥分布、抗骨质疏松药使用方面比较差异均有统计学意义(P<0.05)。单因素logistic回归分析显示:年龄、性别、体重指数、骨密度、骨水泥注入量、骨水泥渗漏、骨水泥分布呈致密型、未使用抗骨质疏松药是术后邻近椎体骨折的可能危险因素;多因素logistic回归分析显示:年龄、骨密度、骨水泥注入量、骨水泥渗漏、骨水泥分布、未使用抗骨质疏松药是PVP术后邻近椎体骨折的高危独立因素。结论年龄越大、低骨密度(T<-3.185 SD)、骨水泥渗漏、骨水泥分布呈致密型、未使用抗骨质疏松药的患者PVP术后发生邻近椎体骨折的风险更大。

Objective To investigate the related risk factors of adjacent vertebral fractures after percutaneous vertebroplasty(PVP)for osteoporotic vertebral compression fracture(OVCF).Methods The 267 patients with OVCFs who underwent PVP were divided into non-refracture group(n=219)and re-fracture group(n=48),according to the adjacent vertebrae whether or not fracture.The age,sex,body height,body mass,bone mineral density(BMD),injection volume of bone cement,cement leakage,bone cement distribution(dense and diffuse type),vertebral height recovery rate,and postoperative whether use of anti-osteoporosis drugs were recorded.Univariate and multivariate logistic regression analyses were performed to analyze the high-risk independent factors of adjacent vertebral fractures.Results There were statistical significances for age,sex,body mass index(BMI),BMD,injection volume of bone cement,bone cement leakage,bone cement distribution,and the use of anti-osteoporosis drugs between the two groups(P<0.05).Univariate logistic regression analysis showed that the age,sex,BMI,BMD,injection volume of bone cement,bone cement leakage,dense type distribution of bone cement and non-use of anti-osteoporotic drugs were possible risk factors for postoperative adjacent vertebral fractures.Multivariate logistic regression analysis showed that the age,BMD,the injection volume of bone cement,cement leakage,cement distribution,and non-use of anti-osteoporotic drugs were high-risk independent factors for adjacent vertebral fractures after PVP.Conclusions The patients with older age,low BMD(T<-3.185 SD),bone cement leakage,dense type cement distribution,and no using anti-osteoporosis drugs have a greater risk of adjacent vertebral fractures.