骨质疏松椎体压缩骨折保守治疗后不愈合的危险因素

Risk factors of nonunion of osteoporotic vertebral compression fracture after conservative therapy

[目的]分析骨质疏松椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)不愈合的影像学特点及影响其不愈合的危险因素。[方法]回顾性分析本院2014年12月~2017年12月收治的经保守治疗的256例OVCF患者临床资料,依据各种影像学方法,包括X线片、CT、MRI评估骨折是否愈合,并比较影像表现特点。对可能影响OVCF不愈合的原因进行单因素分析及Logistic多元回归分析。[结果]256例OVCF患者中共有58例患者出现不愈合,发生率为22.66%,主要集中在T12、L1。X线片检出率为36.21%,CT检出率为67.24%,MRI检出率为89.66%。与OVCF愈合者相比,OVCF不愈合者的年龄更大(≥70岁)、骨折程度更严重(重度)、骨密度T值更低(≤-2.5),且有合并骨折、糖尿病、骨折愈合形态为楔形,两组间上述指标差异均有统计意义(P<0.05)。多因素逻辑回归表明:影响OVCF不愈合的危险因素由高到低依次为年龄(OR=4.615,P<0.001)、骨密度T值(OR=3.924,P<0.001)、骨折形态(OR=2.508,P=0.005)、骨折程度(OR=1.627,P=0.002)、合并骨折病史(OR=1.219,P=0.013)及合并糖尿病(OR=1.136,P=0.010)。但性别与是否合并心血管病对OVCF不愈合无显著影响(P>0.05)。[结论]骨质疏松椎体压缩骨折不愈合主要发生在胸腰段结合处,影像学常见真空裂隙征及液体征。影响骨质疏松椎体压缩骨折不愈合的因素较多,临床上应针对上述影响因素进行防范及治疗,以促进患者康复。

[Objective]To explore the imaging features and the risk factors of nonunion of osteoporotic vertebral compres⁃sion fracture(OVCF)after conservative therapy.[Methods]A retrospective study was done on 256 patients who received conser⁃vative therapy for OVCF in our hospital from December 2014 to December 2017.Based on radiographic examinations conduct⁃ed,including X ray film,computer tomography(CT)and magnetic resonance imaging(MRI),whether or not the OVCF healing was determined and the image characteristics were recorded.Univariate analysis and multiple logistic regression were per⁃formed for searching the risk factors of OVCF nonunion.[Results]Of the 256 patients,58 patients were proved OVCF non⁃union,accounted for 22.66%,mainly involving T12 and L1.The detection rate was 36.21%by X-ray film,while 67.24%by CT,and 89.66%by MRI.Compared with those who had OVCF healed,the patients who were proved OVCF nonunion were signifi⁃cantly more aged(≥70 years),more severe extent of fracture,lower T value of bone density(≤-2.5),and accompanied with his⁃tory of combined fractures,diabetes mellitus and wedge-shaped OVCF,which were statistically significant between the two groups(P<0.05).In term of logistical regression analysis,the risk factors of OVCF nonunion were ranked in a sequence as fol⁃lows:the age(OR=4.615,P<0.001),T value of bone density(OR=3.924,P<0.001),fracture morphology(OR=2.508,P=0.005),extent of fracture(OR=1.627,P=0.002),history of combined fractures(OR=1.219,P=0.013)and diabetes(OR=1.136,P=0.010)although the gender and cardiovascular disease did not impact OVCF healing(P>0.05).[Conclusion]The OVCF non⁃union mainly occurs in the thoracolumbar junction,and usually presents vacuum fissure and fluid sign in images.The advanced age,low bone density,wedge-shaped OVCF,severe extent of fracture,history of combined fractures and diabetes are the risk factors of OVCF nonunion.