老年骨质疏松性椎体压缩骨折经皮椎体后凸成形术后椎体再发骨折的危险因素分析

Risk Factors of Secondary Fracture after Percutaneous Kyphoplasty in Elderly Osteoporotic Vertebral Compression Fracture

目的:探讨经皮椎体后凸成形术(Percutaneous Kyphoplasty,PKP)治疗老年骨质疏松性椎体压缩骨折术后椎体再发骨折的危险因素.方法:回顾性纳入分析2015年1月-2018年12月我院骨科收治的老年骨质疏松性椎体压缩骨折并经PKP术治疗的198例患者.术后至少随访1年时间,详细记录可能的风险因素,包括年龄、性别、身高体质量指数、骨折节段、户外活动、骨密度、骨水泥注射量、骨水泥分布、骨水泥渗漏、术后抗骨质疏松治疗、基础疾病史.采用线性回归分析评价相关风险因素.结果:患者平均随访时间为16.8个月(12-43个月),末次随访时共有27(13.6%)例患者出现椎体再发骨折,骨折节段分布以T12及L1最为常见.多因素回归分析模型显示高龄是PKP术后椎体再发骨折的高危风险因素(P=0.017);而高水平的骨密度值(P<0.001)及积极的户外活动(P=0.037)降低了PKP术后椎体再发骨折的风险.结论:高龄是老年骨质疏松性椎体压缩骨折PKP术后椎体再发骨折的高危因素,而高水平的骨密度值及积极的户外活动可以降低再发骨折的风险.手术医生术前需识别再发骨折的危险因素,给患者以风险提示.

Objective:To investigate the risk factors of recurrent vertebral fractures after percutaneous kyphoplasty(PKP)in the treatment of senile osteoporotic vertebral compression fractures.Methods:A retrospective analysis was performed on 198 patients with osteoporotic vertebral compression fractures treated in our department of orthopedics from January 2015 to December 2018 and treated with PKP.Follow-up for at least one year after surgery,and record possible risk factors,including age,gender,height and body mass index,fracture segment,outd(X)r activities,bone density,bone cement injection volume,bone cement distribution,bone leakage History of anti-osteoporosis treatment and underlying diseases.Linear regression analysis was used to evaluate relevant risk factors.Results:The average follow-up time was 16.8 months(12-43 months).At the last follow-up,a total of 27(13.6%)patients had recurrent vertebral fractures.T12 and LI were the most common fracture segments.Multivariate regression analysis model showed that advanced age was a high risk factor for vertebral recurrence jfractures after PKP(P=0.017);high levels of bone mineral density(P<0.001)and active outdoor activities(P=0.037)decreased Risk of vertebral fractures after PKP.Conclusion:Older age is a high risk factor for recurrent vertebral fractures after PKP in elderly osteoporotic vertebral compression fractures,and high levels of bone mineral density and active outdoor activities can reduce the risk of recurrent fractures.The surgeon needs to recognize the risk factors of recurrence of fractures before operation,and give the patient a risk reminder.