骨质疏松性椎体压缩骨折经皮椎体成形术后再手术的影响因素分析

The influencing factors of reoperation after percutaneous vertebroplasty for osteoporotic vertebral compression fractures

目的探讨骨质疏松性椎体压缩骨折经皮椎体成形术后再手术的影响因素,以期为患者的临床治疗提供参考价值。方法采用回顾性分析,收集2016年6月至2021年6月期间,在我院脊柱外科因骨质疏松性椎体压缩骨折行椎体成形术的患者,符合入组标准的患者共183例,其中术后再手术患者32例作为观察组,术后未再手术患者151例作为对照组,收集2组患者的性别、年龄、体质指数(BMI)、既往骨折病史、术前骨密度、Oswestry功能障碍指数(ODI)、活动能力评分(LAS)、后凸Cobb角矫正度、骨水泥渗漏情况、抗骨质疏松药使用情况等资料,采用独立样本t检验、χ2检验、Logistic回归分析,P<0.05为差异具有统计学意义。结果术前观察组、对照组患者的ODI、LAS得分比较,差异均无统计学意义(P均>0.05)。术后观察组和对照组患者ODI、LAS得分比较,差异有统计学意义(P<0.05)。观察组与对照组患者在性别、BMI方面组间对比差异无统计学意义(P>0.05);在年龄、骨折病史、骨密度、后凸Cobb角矫正度、骨水泥渗漏情况和使用抗骨质疏松药物方面组间对比,差异均有统计学意义(P均<0.05)。多因素Logistic回归分析显示,年龄>70岁、有骨折病史、术前骨密度<-3.2SD、后凸Cobb角矫正度>15°、存在骨水泥渗漏情况、未使用抗骨质疏松药等因素是影响患者术后再手术的主要因素。结论影响骨质疏松性压缩骨折经皮椎体成形术后再手术的因素主要有:年龄>70岁、有骨折病史、骨密度<-3.2SD、Cobb角>15°、存在骨水泥渗漏情况以及未使用抗骨质疏松药,应注意针对上述影响因素给予预防性干预措施。

Objective To explore the influencing factors of reoperation after percutaneous vertebroplasty for osteoporotic vertebral compression fractures,in order to provide reference value for the clinical treatment of patients.Methods The patients who underwent vertebroplasty for osteoporotic vertebral compression fractures in the spine surgery department of our hospital from June 2016 to June 2021 were retrospetively analyzed.A total of 183 patients met the inclusion criteria,including thirty-two patients with postoperative reoperation were taken as the observation group,and 151 patients without reoperation after the operation who were taken as the control group.The gender,age,body mass index(BMI),previous fracture history,preoperative bone mineral density,Oswestry disability index(ODI),activity ability scores(LAS)of the two groups were collected.Scores,kyphotic Cobb angle correction,bone cement leakage,use of anti-osteoporosis drugs and other data were analyzed by independent samples t test,chi-square test,and Logistic regression analysis.P<0.05 was considered statistically significant.Results There was no significant difference in ODI and LAS between the observation group and the control group before operation(all P>0.05).There were significant differences in ODI andLAS scores between the observation group and the control group after operation(P<0.05).There was no significant difference in gender and BMI between the observation group and the control group(P>0.05).There were significant differences in age,fracture history,bone mineral density,correction of kyphosis Cobb angle,bone cement leakage anduse of anti-osteoporosis drugs.Multivariate Logistic regression analysis showed that>70 years old,a history of fracture,the preoperative bone mineral density less than-3.2SD,the correction of thekyphotic Cobb angle>15 degrees,bone cement leakage,and no anti-osteoporosis drugs used were the main factors affecting the reoperation of patients after surgery.Conclusion Factors affecting reoperation after percutaneous vertebroplasty for osteoporotic compression fractures mainly include:age greater than 70 years,history of fracture,bone mineral density less than-3.2SD,Cobb angle greater than 15 degrees,bone cement leakage, and anti-osteoporosis drugs are not used. Preventive interventions should be given based on the above influencing factors in the future.