经皮椎体后凸成形术后邻近节段再骨折的危险因素分析

Risk factors for adjacent segment refracture after percutaneous kyphoplasty

目的对经皮椎体后凸成形术(PKP)术后邻近椎体再骨折的相关危险因素进行分析和探讨,以减少骨质疏松性椎体压缩性骨折(OVCF)术后邻近节段再骨折的发生。方法收集2016年1月—2017年12月浙江中医药大学附属第二医院骨科行PKP术治疗的438例单节段OVCF患者的资料进行回顾性分析。依据PKP术后是否发生邻近节段再骨折分为再骨折组(32例)和非骨折组(257例)。比较2组患者的年龄、性别、体重指数、胸腰段比例、骨密度、骨水泥注入量、椎体高度恢复率、骨水泥渗漏情况、随访期间外伤情况及再骨折时骨密度,对这些因素进行单因素分析,将其中差异有统计学意义的因素纳入多因素logistic回归模型中,分析其与邻近节段再骨折的相关性。结果289例患者随访资料完整并纳入本研究,术后随访12~24(13.5±0.9)个月。至末次随访,术后共32例患者新发生邻近椎体骨折。单因素分析结果显示,邻近节段再骨折与再骨折时骨密度和随访期间外伤情况有关(均P<0.05)。多因素logistic回归分析结果显示,再骨折时骨密度(OR=0.225)是术后邻近节段再骨折的影响因素(P<0.01);随访期间轻微外伤(OR=5.254)可能是导致再骨折发生的重要外部影响因素(P<0.01)。结论PKP术后邻近节段再骨折的发生主要原因是骨质疏松的进展和随访期间的再次外伤。因此术后早期腰围保护和正规抗骨质疏松治疗及避免外伤必不可少。

Objective To analyze the risk factors for adjacent segment refracture after percutaneous kyphoplasty(PKP),so as to reduce the incidence of adjacent segmental refracture in patients with osteoporotic vertebral compression fracture(OVCF)after PKP.Methods Total 438 patients with single-segment OVCF treated by PKP in the Department of Orthopedics of the Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from January 2016 to December 2017 were collected and analyzed retrospectively.The patients were divided into refracture group(32 cases)and non-fracture group(257 cases)according to the occurrence of adjacent segment fracture after PKP.The age,gender,body mass index(BMI),proportion of injured vertebrae in thoracolumbar segment,bone mineral density,bone cement injection volume,recovery rate of vertebral height,bone cement leakage,trauma during follow-up and bone mineral density during refracture in the two groups were analyzed by univariate analysis.The statistically significant factors were put into logistic regression to analyze their correlation with adjacent segment refractures after PKP.Results The follow-up data of 289 patients were complete and included in this study,the postoperative follow-up was 12 to 24(13.5±0.9)months.Up to the last follow-up,32 patients had new adjacent vertebral fractures.Univariate analysis showed that the refracture of adjacent segments was correlated with bone mineral density at the time of refracture and trauma during follow-up(P<0.05).Multivariate logistic regression analysis showed that the bone mineral density at the time of refracture(OR=0.225)was the influencing factor of postoperative adjacent segment refracture(P<0.01).Minor trauma during follow-up(OR=5.254)might be an important external factor leading to the occurrence of adjacent segment refracture(P<0.01).Conclusion The main causes of adjacent segment refracture after PKP are severe osteoporosis and trauma during follow-up.Therefore,early postoperative waist protection,effective anti-osteoporosis treatment and avoidance of trauma are essential.