经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折后再骨折的危险因素分析

Risk Factors for Re-fracture after Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fracture

目的探讨骨质疏松性椎体压缩骨折(OVCF)病人行经皮椎体后凸成形术(PKP)术后再骨折的危险因素。方法回顾性分析2005年1月至2021年8月于我院诊断为骨质疏松性椎体压缩骨折并行PKP治疗的病人1829例,其中女1412例,男417例。根据PKP术后是否发生再次骨折,将病人分为再发骨折组(224例)和未再发骨折组(1605例)。统计病人的性别、年龄、身体质量指数(BMI)、骨密度、术后侧(后)凸畸形的度数、椎体高度恢复率、初始骨折椎体数量、术前保守治疗时间、术后抗骨质疏松药物的使用、骨水泥渗漏、疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)进行单因素分析及多因素Logistic回归分析。结果单因素分析显示性别、年龄、BMI、骨密度、术后抗骨质疏松药物的使用、骨水泥渗漏及术前保守治疗时间均与再骨折的发生有关(P<0.05);病人术后侧(后)凸畸形的度数、初始椎体骨折数量、术后椎体高度的恢复率、手术前后VAS评分和ODI与再骨折无明显相关性(P>0.05)。通过Logistic回归分析发现女性(OR=4.355,95%CI:1.598~17.908,P=0.006)、65岁及以上(OR=6.431,95%CI:1.756~23.233,P=0.003)、BMI≥23 kg/m^(2)(OR=3.561,95%CI:0.787~12.065,P=0.037)、骨密度T值<-2.5 SD(OR=10.352,95%CI:2.857~41.761,P<0.001)、术后未使用抗骨质疏松药物(OR=6.070,95%CI:1.731~21.165,P=0.003)、骨水泥渗漏(OR=6.150,95%CI:1.671~16.177,P=0.004)为PKP术后再发骨折的独立危险因素。结论PKP术中应仔细操作,尽量避免骨水泥渗漏;对于女性、高龄、BMI高、骨密度过低的病人行PKP术后应重点关注;术后进行规律的抗骨质疏松治疗,避免再骨折的发生。

Objective To investigate the risk factors for re-fracture of osteoporotic vertebral compression fracture(OVCF)treated with percutaneous kyphoplasty(PKP).Methods A retrospective analysis was performed on 1829 patients diagnosed with OVCF and treated with PKP from January 2005 to August 2021in our hospital,including 1412 females and 417 males.According to the re-fracture type,patients were divided into re-fracture group and no re-fracture group.Gender,age,body mass index(BMI),bone mineral density(BMD),postoperative degree of scoliosis and kyphosis,postoperative recovery rate of vertebral height,number of fractured vertebral bodies,duration of preoperative conservative treatment,postoperative anti-osteoporosis treatment,bone cement leakage,visual analogue scale(VAS)score,Oswestry disability index(ODI)were analyzed.The related factors were analyzed by univariate and multivariate Logistic regression analysis.Results Gender,age,BMI,BMD,postoperative anti-osteoporosis treatment,bone cement leakage,duration of preoperative conservative treatment were related to the re-fracture(P<0.05).There was no significant correlation between the degree of postoperative scoliosis angle,the degree of postoperative scoliosis deformity,the number of initial fractured vertebral bodies,the recovery rate of postoperative vertebral height,VAS,ODI and the re-fracture(all P>0.05).Multivariate Logistic regression analysis showed that female(OR=4.355,95%CI:1.598-17.908,P=0.006),age≥65 years(OR=6.431,95%CI:1.756-23.233,P=0.003),BMI≥23 kg/m^(2)(OR=3.561,95%CI:0.787-12.065,P=0.037),BMD<-2.5 SD(OR=10.352,95%CI:2.857-41.761,P<0.001),postoperative no anti-osteoporosis treatment(OR=6.070,95%CI:1.731-21.165,P=0.003),bone cement leakage(OR=6.150,95%CI:1.671-16.177,P=0.004)were risk factors for postoperative re-fracture after PKP.Conclusion PKP should be operated carefully to avoid cement leakage.We should pay more attention to the female,old age,high BMI,low bone mineral density patients after PKP.Regular anti-osteoporosis treatment was performed after operation to avoid the occurrence of re-fracture.