骨质疏松性椎体压缩骨折经皮椎体后凸成形术后两年椎体再骨折危险因素Logistics分析研究

Logistic regression analysis on risk factors of osteoporotic vertebral compression fracture 2 years after percutaneous kyphoplasty

目的 研究骨质疏松性椎体压缩骨折 (osteoporotic vertebral compression fracture,OVCF) 患者采用经皮椎体后凸成形术 (percutaneous kyphoplasty,PKP) 术后 2 年再次发生 OVCF 的危险因素。方法 选取因 OVCF 住院行 PKP 的患者 694 例,依据术后是否再次出现新的 OVCF,分为再次骨折组和对照组。记录患者年龄、性别、身高、体重、体质量指数 (body mass index,BMI)、糖尿病病史、骨折节段、骨密度和术后抗骨质疏松治疗情况,分析 PKP 术后非手术椎体再次出现 OVCF 的危险因素。结果 术后随访 2 年,再次出现 OVCF 的患者 98 例 (14.1%),合计发生 OVCF 124 例次,累及 361 个椎体,分布范围 T_(4)~L_(5)椎体。多因素 Logistics 回归分析显示,术后使用双膦酸盐类药物 (OR=0.32,P=0.002) 和 QCT 值增高 (OR=0.95,P=0.028),对于出院后再次发生 OVCF 有保护作用。DEXA-T 值 (P=0.004) 和补钙补维生素 D (P=0.011) 虽然组间差异有统计学意义,但是在回归分析中对再发新 OVCF 的影响差异无统计学意义 (OR=1.39,P=0.377;OR=0.90,P=0.788)。结论 OVCF 患者行 PKP 治疗后 2 年再次出现 OVCF 的发生率为 14.1%,术后使用双膦酸盐类药物有利于降低 OVCF 的再次发生。腰椎定量 CT 对于术后检测骨密度变化具有重要的临床价值。

Objective To explore the high-risk factors of osteoporotic vertebral compression fracture (OVCF)2 years after percutaneous kyphoplasty (PKP).Methods This analysis was conducted on 694 OVCF patients who underwent PKP in Beijing Jishuitan Hospital.The cases meeting the inclusion and exclusion criteria were divided into two groups:re-OVCF group and control group.All cases who suffering from another new OVCFs postoperatively were collected in the re-OVCF group during 24 months’ follow-up.The following covariates were reviewed:age,gender,height,weight,body mass index (BMI),history of diabetes,fracture segments,bone mineral density (BMD) and anti-osteoporosis therapy.Univariate analysis was performed on these factors,and the statistically significant factors were substituted into the logistic regression model to analyze their correlation with the another new OVCFs after PKP.Results A total of 98 (14.1%) from 694 patients suffered from another new OVCFs during 24 months’ follow-up.There were a total of 124 new OVCFs from T_(4)-L_(5).The multiple factors logistic regression elucidated that diphosphate medicines postoperatively (OR=0.32,P=0.002) and high QCT value (OR=0.95,P=0.028) were negatively related to the another new OVCFs,which meant protective factors after PKP.Although the difference was statistically significant (P < 0.05) in univariate analysis of high DEXA-T value and Calcium / Vitamin D supplementation,the logistic regression showed that they were not protective factors for new OVCFs after PKP.Conclusions 14.1% patients suffer from another new OVCFs after PKP in 2 years.Application of diphosphate medicines postoperatively can decrease another new OVCFs rate after PKP.Bone mineral density measurements of lumbar vertebra by QCT play an important role on the monitoring of osteoporosis after operation.