骨质疏松性椎体压缩性骨折经皮椎体成形术后继发椎体再骨折的相关因素分析

Analysis of factors related to secondary vertebral re-fracture after percutaneous vertebroplasty for osteoporotic vertebral compression fracture

目的探讨骨质疏松性椎体压缩性骨折(OVCF)采用经皮椎体成形术(PVP)治疗后继发椎体再骨折的相关因素,为预防术后椎体再骨折提供参考依据和理论指导。方法回顾性分析2019年3月—2020年3月在内蒙古自治区人民医院采用PVP治疗的178例OVCF患者临床资料。收集所有患者性别、年龄、体质量指数(BMI)、骨密度T值、住院时间、手术穿刺路径、骨水泥注入量、骨水泥弥散情况、骨水泥渗漏情况、椎体高度恢复率、术后即刻Cobb角及术后支具佩戴时间,并采用多因素logistic回归分析评价这些因素与术后椎体再骨折的相关性。结果共29例患者PVP术后发生继发椎体再骨折,再骨折发生率为16.3%(29/178)。再骨折患者与无再骨折患者在年龄、骨水泥注入量、骨水泥渗漏情况、椎体高度恢复率、术后即刻Cobb角及术后支具佩戴时间6个方面差异有统计学意义(P<0.05)。将上述6个因素纳入多因素logistic回归分析,结果显示,骨水泥注入量≥4 mL、骨水泥渗漏、椎体高度恢复率≥10%及术后支具佩戴时间<2个月是术后椎体发生再骨折的危险因素。结论OVCF患者PVP术后邻近椎体再骨折与术中骨水泥注入量过大、骨水泥渗漏、椎体高度过度恢复以及术后支具佩戴时间过短密切相关,临床上应尽量避免,以期降低术后椎体再骨折发生率,提高患者术后远期预后水平。

Objective To investigate the factors related to secondary vertebral re-fracture after percutaneous vertebroplasty(PVP)for osteoporotic vertebral compression fracture(OVCF),so as to provide a reference base and theoretical guidance for the prevention of postoperative vertebral refracture.Methods The clinical data of 178 OVCF patients who were treated with PVP in the People’s Hospital of Inner Mongolia Autonomous Region from March 2019 to March 2020 were analyzed retrospectively.The gender,age,body mass index(BMI),T value of bone mineral density,hospital stay,surgical puncture approach,amount of bone cement injection,leakage of bone cement,recovery rate of vertebral height,Cobb angle immediately after operation and postoperative brace wearing time were collected,and multivariate logistic regression analysis was used to evaluate the correlation between these factors and postoperative vertebral re-fracture.Results A total of 29 patients had secondary vertebral re-fracture after PVP,and the incidence of re-fracture was 16.3%(29/178).There were significant differences between patients with re-fracture and patients without re-fracture in age,amount of bone cement injected,leakage of bone cement,recovery rate of vertebral height,Cobb angle immediately after operation and postoperative brace wearing time(P<0.05).The above 6 factors were included in the multivariate logistic regression analysis.The results showed that the amount of bone cement injected≥4 mL,bone cement leakage,vertebral height recovery rate≥10%,and the postoperative brace wearing time<2 months were the risk factors for postoperative vertebral re-fracture.Conclusions The re-fracture of adjacent vertebrae in OVCF patients after PVP is closely related to excessive intraoperative bone cement injection,bone cement leakage,excessive recovery of vertebral height,and too short postoperative brace wearing time.In clinical practice,it should be avoided as far as possible to reduce the incidence of postoperative vertebral re-fracture and improve the long-term prognosis of the patients.