维生素D水平与椎体强化术后再发非术椎骨折的相关性分析

Correlation Analysis of Vitamin D Level with Nonoperative Vertebral Refracture After Vertebral Augmentation

目的研究血清维生素D水平与椎体强化术(percutaneous vertebral augmentation,PVA)后非手术椎体发生骨折的相关性。方法收集2017年1月至2021年1月昆明市第一人民医院骨科收治的骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)行单节段双侧入路PVA治疗的112例患者资料,包括年龄、性别、术前骨密度、术前25-羟基维生素D值、手术方式、手术椎体节段、术后复查血清25-羟基维生素D值等资料,根据患者PVA术后是否发生非术椎骨折将所有患者分为骨折组和非骨折组,非骨折组患者51例,其中男性10例,女性41例;平均年龄(73.3±9.7)岁。骨折组61例患者,其中男性13例,女性48例;平均年龄(75.0±8.5)岁。分析两组患者血清维生素D水平差异是否有统计学意义。结果术后随访3~24个月,两组患者的性别、年龄、骨密度值、手术方式比较差异无统计学意义(P>0.05);术后抗骨质疏松治疗情况比较,差异有统计学意义(P<0.05);术后骨折组和非骨折组复查25-羟基维生素D值差异有统计学意义(P<0.05),术后未抗骨质疏松治疗的患者再发骨折的风险大约是术后有抗骨质疏松治疗患者的4.13倍,术后补充维生素D,血清25-羟基维生素D值每提升1 ng/mL,再发骨折的风险降低约5.8%。结论PVA术后规律补充维生素D以及抗骨质疏松治疗可以减少PVA术后再发骨折。

Objective To study the relationship between serum vitamin D level and non-operative recurrent vertebral fracture after percutaneous vertebral augmentation(PVA).Methods The basic data of patients with osteoporotic vertebral compression fracture(OVCF)treated by PVA in the Department of Orthopaedics of Kunming first people's Hospital from January 2017 to January 2021 were collected,including age,sex,preoperative bone mineral density,25-hydroxyvitamin D value,mode of operation,operative vertebral segment and serum 25-hydroxyvitamin D value after operation.The patients were followed up for 3~24 months.According to whether the patients had recurrent non-operative vertebral fracture after PVA,all patients were divided into fracture group and non-fracture group.In the non-fracture group,there were 51 patients,including 10 males and 41 females.The mean age was(73.3±9.7)years.In the fracture group,there were 61 patients,including 13 males and 48 females.The mean age was(75.0±8.5)years.The difference of serum vitamin D level between the two groups was analyzed.Results Postoperative follow-up was 3~24 months,There was no significant difference in sex,age,bone mineral density and mode of operation between the two groups(P>0.05),but there was significant difference in postoperative anti-osteoporosis treatment(P<0.05).There was significant difference in postoperative 25-hydroxyvitamin D between fracture group and non-fracture group(P<0.05).The risk of recurrent fracture in patients without postoperative anti-osteoporosis treatment was about 4.13 times higher than that in patients with postoperative anti-osteoporosis treatment.Postoperative vitamin D supplementation and a 1 ng/ml increase in serum 25-hydroxyvitamin D reduced the risk of recurrent fracture by about 5.8%.Conclusion Regular vitamin D supplementation and anti-osteoporosis therapy after PVA can reduce the incidence of recurrent fracture after PVA.