老年骨质疏松性椎体压缩性骨折椎体成形术术后邻近椎体压缩性骨折发生的影响因素

Influencing factors of adjacent vertebral compression fracture after vertebroplasty in elderly patients with osteoporotic vertebral compression fracture

目的分析老年骨质疏松性椎体压缩性骨折(OVCF)椎体成形术后邻近椎体压缩性骨折发生的影响因素。方法对350例行椎体成形术的老年OVCF患者随访2年,其中122例患者发生邻近椎体压缩性骨折(骨折组),228例患者未发生邻近椎体压缩性骨折(未骨折组);比较两组基本临床资料,并采用Kaplan-Meier生存曲线和Cox回归模型分析邻近椎体压缩性骨折发生的影响因素。结果两组血脂异常和胰岛素抵抗(IR)患者比例以及骨密度T值比较差异有统计学意义(P<0.01)。生存分析显示,血脂异常和IR会增加老年OVCF患者椎体成形术后邻近椎体压缩性骨折的发生风险(P<0.05)。Cox回归分析显示,血脂异常和IR是老年OVCF患者椎体成形术后发生邻近椎体压缩性骨折的危险因素(HR=4.122和3.246,P<0.05),而骨密度T值是其保护因素(HR=0.548,P<0.05)。结论血脂异常和IR是老年OVCF患者椎体成形术后发生邻近椎体压缩性骨折的危险因素,临床上应关注并进行有效干预。

Objective To analyze the influencing factors of adjacent vertebral compression fracture after vertebroplasty in the elderly patients with osteoporotic vertebral compression fracture(OVCF).Methods A total of 350 elderly patients with OVCF after vertebroplasty were followed up for two years,of whom 122 cases had adjacent vertebral compression fracture(group A)and 228 cases had no fracture(group B).The clinical data were compared between the two groups.The factors influencing the occurrence of adjacent vertebral compression fracture were analyzed by Kaplan-Meier survival curve and Cox regression model.Results There was a significant difference in the proportions of the patients with abnormal blood lipids,insulin resistance(IR)and T value of bone mineral density between groups of A and B(P<0.05).The survival analysis showed that the abnormal blood lipids and IR may increase the risk for the occurrence of adjacent vertebral compression fracture after vertebroplasty in elderly patients with OVCF(P<0.05).The Cox regression analysis demonstrated that the abnormal blood lipids and IR were the risk factors(HR=4.122 and 3.246,P<0.05),while the T value of bone mineral density was the protective factor for the occurrence of adjacent vertebral compression fracture(HR=0.548,P<0.05).Conclusion The abnormal blood lipids and IR are the risk factors for the occurrence of adjacent vertebral compression fractures after vertebroplasty in elderly patients with OVCF,so more attention and effective intervention should be paid to.