老年骨质疏松性椎体压缩性骨折患者经皮椎体成形术后发生延迟愈合的影响因素

Factors influencing delayed healing after percutaneous vertebroplasty in elderly patients with osteoporotic vertebral compression fractures

目的分析老年骨质疏松性椎体压缩性骨折(OVCF)患者经皮椎体成形术(PVP)后发生延迟愈合的影响因素。方法纳入2019年1月—2020年12月接受PVP治疗且术后未发生延迟愈合的62例老年OVCF患者(未发生组),以及同期接受PVP治疗且术后发生延迟愈合的62例老年OVCF患者(发生组)。比较2组一般资料、影像学指标和实验室检测指标的差异,通过logistic回归分析研究老年OVCF患者PVP术后发生延迟愈合的影响因素。结果发生组的存在椎体裂隙征比例、伤椎高度恢复率和脱氧吡啶酚(DPD)水平高于未发生组,骨密度T值和胰岛素样生长因子-1(IGF-1)水平低于未发生组,差异均有统计学意义(P<0.05)。多元logistic回归分析结果显示,存在椎体裂隙征[比值比(OR)为8.622,95%置信区间(CI)为1.540~48.264]、伤椎高度恢复率高(OR为1.184,95%CI为1.069~1.311)、骨密度T值低(OR为0.009,95%CI为0.000~0.211)、DPD水平高(OR为1.031,95%CI为1.001~1.062)、IGF-1水平低(OR为0.936,95%CI为0.898~0.975)是老年OVCF患者PVP术后发生延迟愈合的危险因素。结论老年OVCF患者PVP术后发生延迟愈合可能与存在椎体裂隙征、骨密度T值低、伤椎高度恢复率高、DPD过高及IGF-1过低有关。重视伴有上述因素的老年OVCF患者PVP术后的早期评估及合理干预,可能对促进良性预后有积极意义。

Objective To analyze the factors influencing delayed healing after percutaneous vertebroplasty(PVP)in elderly patients with osteoporotic vertebral compression fractures(OVCF).Methods The clinical data of 62 elderly patients with OVCF who were treated with PVP without delayed healing from January 2019 to December 2020 were included as the non-occurrence group,and 62 elderly patients with OVCF who were treated with PVP during the same period and with delayed healing were included as the occurrence group.The general data,imaging data and laboratory index test results were compared between the 2 groups,and the factors influencing delayed healing were found out through logistic regression analysis.Results The proportion of the patients with vertebral fissure sign,recovery rate of injured vertebral height and deoxypyridinol(DPD)level of patients in the occurrence group were higher than those in the non-occurrence group,while the bone mineral density T value and insulin-like growth factor-1(IGF-1)level in the occurrence group were lower than those in the non-occurrence group,all with a statistical significance(P<0.05).The results of multiple logistic regression analysis showed that presence of vertebral fissure sign(odds ratio[OR]8.622,95%confidence interval[CI]1.540-48.264),high recovery rate of injured vertebral height(OR=1.184,95%CI 1.069-1.311),low T value of bone mineral density(OR=0.009,95%CI 0.000-0.211),high level of DPD(OR=1.031,95%CI 1.001-1.062)and low level of IGF-1(OR=0.936,95%CI 0.898-0.975)were risk factors of delayed healing after PVP in elderly OVCF patients.Conclusions The delayed healing after PVP in elderly patients with OVCF may be related to presence of vertebral fissure sign,low T value of bone mineral density,high recovery rate of injured vertebral height,high level of DPD and low level of IGF-1.The early evaluation and reasonable intervention of the elderly OVCF patients after PVP with above factors may have positive significance in promoting the benign prognosis.