预后营养指数、骨密度、骨水泥分布指数对骨质疏松性压缩性骨折椎体成形术后邻近椎体再骨折的预测价值

Predictive value of prognostic nutritional index,bone mineral density and bone cement distribution index for refracture of adjacent vertebral body after vertebroplasty for osteoporotic compression fractures

目的:探讨预后营养指数(PNI)、骨密度、骨水泥分布指数对骨质疏松性压缩性骨折(OVCFs)椎体成形术后邻近椎体再骨折的预测价值。方法:回顾性分析2019年1月~2021年3月于合肥京东方医院接受椎体成形术治疗的OVCFs患者83例。随访12个月,根据患者邻近椎体是否再发骨折分为再骨折组(n=19)和无再骨折组(n=64)。收集患者临床资料,分析OVCFs椎体成形术后邻近椎体再骨折的影响因素。结果:再骨折组患者年龄高于无再骨折组,而骨密度、术后规律接受骨质疏松治疗比例、骨水泥分布指数、PNI低于无再骨折组(P<0.05)。多因素Logistic回归分析显示,骨密度高、PNI高、骨水泥分布指数高、术后规律接受骨质疏松治疗为邻近椎体再骨折的独立保护因素(P<0.05)。ROC曲线显示PNI、骨密度、骨水泥分布指数分别取40.82、-4.12、2.5时预测OVCFs椎体成形术后邻近椎体再骨折的ROC曲线下面积分别为0.743(0.627~0.858)、0.797(0.690~0.904)、0.806(0.705~0.906)(P<0.05)。结论:临床工作中,对于术后未规律接受骨质疏松治疗、PNI低、骨密度低以及骨水泥分布指数低的患者应格外关注,做好健康教育和干预措施,减少再骨折的发生。

Objective:To investigate the predictive value of prognostic nutritional index(PNI),bone mineral density,and bone cement distribution index for refracture of adjacent vertebral bodies after vertebroplasty for osteoporotic compression fractures(OVCFs).Methods:Retrospective analysis was performed in 83 cases of OVCFs undergone vertebroplasty in Hefei BOE Hospital between January 2019 and March 2021.All patients were followed for 12 months,and divided into a refracture group(n=19)and a non-refracture group(n=64)according to whether the adjacent vertebral body had recurrent fractures.The clinical treatment data were collected from all patients to analyze the factors affecting regracture of the adjacent vertebral body following vertebroplasty.Results:Univariate analysis showed that the age of the patients in the refracture group was higher than that in the non-refracture group,while the bone mineral density,the proportion of regular postoperative osteoporosis treatment,bone cement distribution index,and PNI were lower than those in the non-refracture group,with statistical differences(P<0.05).The results showed that high bone mineral density,high PNI,high bone cement distribution index,and regular postoperative osteoporosis treatment were independent protective factors for adjacent vertebral body refractures(P<0.05).The ROC curve showed that PNI,bone mineral density,and bone cement distribution index were 40.82,-4.12,and 2.5,respectively,and the area of the ROC curve for predicting refracture of the adjacent vertebral body after vertebroplasty for OVCFs was the largest,which were 0.743(0.627-0.858),0.797(0.690-0.904),0.806(0.705-0.906),respectively(P<0.05).Conclusion:In clinical practice,special attention should be paid to patients who failed to receive regular osteoporosis treatment,and those with low PNI,bone mineral density and bone cement distribution index after surgery.In addition,health education and intervention measures are also important in preventing and reducing the occurrence of refractures in such patients.