骨代谢标志物与骨密度预测经皮穿刺椎体成形术后椎体再骨折的价值

Bone mineral density and bone metabolism markers for predicting vertebral refracture in elderly patients after percutaneous vertebroplasty

目的探讨椎体骨密度及骨代谢标志物在老年骨质疏松性胸腰椎骨折经皮穿刺椎体成形术(percutaneous vertebro plasty,PVP)后预测椎体再骨折发生的价值。方法采用回顾性分析方法收集2018年1月-2019年1月在同济大学附属第十人民医院接受椎体成形术治疗的老年骨质疏松性胸腰椎压缩性骨折患者50例,其中术后12个月相邻椎体再骨折23例(经影像学证实),根据相邻椎体是否再次骨折分为骨折组和未骨折组。采用双能X线骨密度仪测定并记录患者术前及术后6、12个月病椎相邻椎体和髋部骨密度,酶联免疫吸附法(ELISA)进行血清骨钙素N端中分子片段(N-terminal middle molecular fragment of osteocalcin,N-MID)和25羟维生素D[25 hydroxyvitamin D,25(OH)D]检测。结果未骨折组强化椎体的相邻椎体骨密度(bone mineral density,BMD)在术后6、12个月降低(P=0.000),组内两两比较术前至术后12个月BMD持续降低,降低率分别为7.80%和18.50%(P=0.000);术后6、12个月再骨折组髋部BMD低于未骨折组(P<0.001,P=0.000);再骨折组血清N-MID和25(OH)D浓度均低于未骨折组(P=0.000),Logistic回归分析显示再骨折的发生与血清N-MID浓度呈负相关(P=0.033),与25(OH)D的浓度呈负相关(P=0.031)。结论PVP术后相邻椎体和髋部BMD、N-MID、25(OH)D降低的老年骨质疏松患者容易发生相邻椎体的再骨折。

Objective To assess the value of vertebral bone mineral density(BMD)and bone metabolism markers for predicting vertebral refracture after percutaneous vertebroplasty(PVP)in elderly patients with osteoporotic thoracolumbar fractures.Methods Fifty elderly patients with osteoporotic thoracolumbar compression fractures treated by bone cement molding in our hospital from January 2018 to January 2019,were included in the study.The adjacent vertebral refractures occurred in 23 cases(refracture group)and did not occur in 27 cases(non-refracture group).Dual energy X-ray absorptiometry(DXA)was used to measure the bone mineral density(BMD)of single non-operated vertebral body and hip before and 6,12 months after operation.Serum osteocalcin N-terminal middle molecular fragment(N-MID)and 25 hydroxyvitamin D[25(OH)D]levels were detected by enzyme-linked immunosorbent assay(ELISA).Results Compared to that before operation,the BMD of adjacent vertebral bodies in the non-fracture group decreased at 6 months and 12 months after operation with the reduction rates of 7.80%and 18.50%(P=0.000),respectively.The BMD of hip in the refracture group was lower than that in the non fracture group at 6 and 12 months after operation(P<0.001,P=0.000).The levels of serum N-MID and 25(OH)D in the refracture group were lower than those in the non-fracture group(P=0.000).Logistic regression analysis showed that the occurrence of refracture was negatively correlated with the serum levels of osteocalcin N-MID and 25(OH)D(P=0.033,P=0.031).Conclusion The decreased BMD of adjacent vertebral body and hip,serum levels of osteocalcin N-MID and 25(OH)D in elderly patients with osteoporosis are prone to refracture of adjacent vertebral bodies after PVP.