超高龄骨质疏松性胸腰椎压缩骨折经皮椎体成形术术后邻椎再骨折的危险因素分析

Risk factors of adjacent vertebral refracture after percutaneous vertebroplasty for osteoporotic vertebral compression fractures in super-old patients

目的:分析超高龄骨质疏松性椎体压缩骨折(osteoporosis vertebral compression fractures,OVCFs)经皮椎体成形术(percutaneous vertebroplasty,PVP)术后邻近椎体再骨折的危险因素。方法:对2012年6月至2019年6月采用PVP治疗的40例超高龄(年龄≥90岁)OVCFs患者进行回顾性分析,其中男7例,女33例;年龄90~101(94.6±1.6)岁。根据是否发生邻近椎体再骨折进行分组,其中20例患者PVP术后发生再骨折(再骨折组),20例术后没有发生邻近椎体再骨折(对照组)。统计两组患者的一般资料、影像学数据、骨盆参数,项目包括年龄,性别,体质量指数(body mass index,BMI),骨折部位,骨密度(bone mineral density,BMD)T值,骨折至手术时间,伤椎压缩程度,伤椎前缘恢复程度,骨水泥注入量,骨水泥是否渗漏,骨盆指数(pelvic index,PI),骨盆倾斜角(pelvic tilt angle,PT),骶骨角(sacral angle,SS)等。将可能与再骨折相关的因素纳入单因素研究,再将单因素分析有统计学意义的危险因素进行多元Logistic回归分析,进一步明确PVP术后邻近椎体再骨折独立危险因素。结果:两组患者的年龄、性别、骨折部位、骨折至手术时间、伤椎压缩程度、伤椎前缘恢复程度比较差异无统计学意义(P>0.05);两组患者的BMI、BMD T值、骨水泥注入量、骨水泥渗漏率比较差异有统计学意义(P<0.05);再骨折组的PI、PT测定值均高于对照组(P<0.05);两组患者的SS测定值差异无统计学意义(P>0.05)。经多元Logistic回归分析显示,BMD T值降低、发生骨水泥渗漏、PT和PI增大将增加OVCFs再次发生邻近椎体骨折的风险(P<0.05)。结论:引起超高龄OVCFs患者术后再次发生邻近椎体骨折的危险因素很多,患者高PI、PT可能是其风险因素之一。

Objective:To analyze the risk factors for refracture of adjacent vertebrae after percutaneous vertebroplasty(PVP)in super-old patients with osteoporotic vertebral compression fractures(OVCFs).Methods:A retrospective analysis was performed on 40 patients(age≥90 years)with OVCFs who underwent PVP between June 2012 and June 2019.There were 7 males and 33 females,age from 90 to 101 years old with an average of(94.6±1.6)years.Patients were divided into two groups according to whether adjacent vertebral refracture occurred after PVP.Among them,20 patients occurred refracture after PVP(refracture group)and 20 patients did not occur it(control group).The general information,radiological data and pelvic parameters of the two groups were collected.The items included age,gender,body mass index(BMI),fracture site and bone mineral density(BMD)T-value,fracture to operation time,compression degree of injured vertebra,recovery degree of anterior edge of injured vertebra,bone cement injection amount,bone cement leakage,pelvic index(PI),pelvic tilt angle(PT),sacral angle(SS),et al.Factors that may be related to refracture were included in the single-factor study,and multivariate Logistic regression analysis was performed on the risk factors with statistical significance in the single-factor analysis to further clarify the independent risk factors for refracture of adjacent vertebral bodies after PVP.Results:There were no significant differences in age,gender,fracture site,fracture to operation time,compression degree of injured vertebra and recovery degree of anterior edge of injured vertebra between two groups(P>0.05).There were significant differences in BMI,BMD T-value,bone cement injection amount and bone cement leakage rate between two groups(P<0.05).The PI and PT values of the refracture group were higher than those of the control group(P<0.05).There was no significant difference in SS between two groups(P>0.05).Multivariate Logistic regression analysis showed that decreased BMD T-value,bone cement leakage,increased PT and PI values increased the risk of recurrence of adjacent vertebral fractures in OVCFs(P<0.05).Conclusion:There are many risk factors for the recurrence of adjacent vertebral fractures in super-old patients with OVCFs.Patients with high PI and PT values may be one of the risk factors.