经皮椎体成形术后邻近椎体继发骨折危险因素分析

Risk factors of secondary fracture of adjacent vertebra after percutaneous vertebroplasty

目的探讨骨水泥灌注量联合骨密度(bone mineral density,BMD)对骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCF)经皮椎体成形术(percutaneous vertebroplasty,PVP)后邻近椎体继发骨折(adjacent vertebral compression fracture,AVCF)的影响和预测作用。方法回顾性分析我院2018年1月至2020年12月收治的627例行PVP的OVCF患者临床资料,根据是否发生AVCF分为骨折组(n=78)和未骨折组(n=549),分析两组患者性别、年龄、高血压、糖尿病、体质量指数(body mass index,BMI)、骨折部位、BMD、骨折椎体压缩率、术前椎体前缘高度、术前Cobb’s角、骨水泥灌注量、术后骨水泥渗漏、骨水泥分布、术后抗骨质疏松治疗、术后椎体前缘高度、术后Cobb’s角恢复程度、矢状面垂直轴偏移量(sagittal vertical axis,SVA)、术后支具佩戴时间、骨水泥灌注量和BMD的差值。采用单因素和多因素Logistic回归分析OVCF患者PVP术后AVCF发生的独立影响因素。绘制受试工作特征曲线(receiver operating characteristic,ROC),计算曲线下面积(area under curve,AUC),评估骨水泥灌注量、BMD、骨水泥灌注量和BMD的差值预测PVP术后AVCF的价值。结果两组患者性别、BMI、糖尿病、高血压等一般资料对比差异无统计学意义(P>0.05);单因素分析发现骨折组年龄、骨水泥灌注量、骨水泥灌注量与BMD差值高于未骨折组(t=7.318、8.535、7.458,P<0.05)、骨折组BMD、术前Cobb’s角低于未骨折组(t=-6.646、-6.541,P<0.05)、骨折组骨水泥渗漏率、骨水泥呈O型分布率、术后未接受抗骨质疏松治疗比例高于未骨折组(χ^(2)=27.643、17.436、25.352,P<0.05);多因素分析发现BMD(95%CI:1.653~3.995、OR:2.241)、骨水泥灌注量(95%CI:1.743~4.635、OR:2.644)、发生骨水泥渗漏(95%CI:1.249~3.016、OR:1.564)、术后未接受抗骨质疏松治疗(95%CI:2.684~6.745、OR:3.024)、骨水泥灌注量与BMD差值(95%CI:1.856~7.849、OR:3.656)是PVP术后发生AVCF的独立影响因素。BMD、骨水泥灌注量、骨水泥灌注量与BMD差值预测AVCF的AUC分别为0.739(95%CI:0.560~0.918)、0.772(95%CI:0.604~0.940)、0.920(95%CI:0.865~0.976),预测临界值(Cut-off值)分别为-3.35、4.45、6.45,灵敏度分别为0.538、0.692、0.846,特异度分别为0.839、0.874、0.785。结论BMD、骨水泥灌注量、发生骨水泥渗漏、术后未接受抗骨质疏松治疗、骨水泥灌注量与BMD差值是PVP术后发生AVCF的危险因素,骨水泥灌注量与BMD差值对AVCF有较好的预测价值,可以用于临床指导。

Objective To explore the effect and prediction of bone cement dosage combined with bone mineral density(BMD)on the occurrence of adjacent vertebral compression fracture(AVCF)in osteoporotic vertebral compression fractures(OVCF)after percutaneous vertebroplasty(PVP).Methods This analysis was conducted on 627 OVCF patients who underwent PKP in Pengzhou People’s Hospital.All cases were divided into two groups:fracture group(n=78)and non-fracture group(n=549).The following covariates were reviewed:gender,age,hypertension,diabetes,body mass index(BMI),fracture site,BMD,ratio of fractured vertebra,preoperative height of anterior vertebral margin,preoperative Cobb’s Angle,bone cement perfusion volume,postoperative bone cement leakage,bone cement distribution,postoperative anti-osteoporosis therapy,height of anterior vertebral edge,recovery degree of Cobb’s Angle after operation,sagittal vertical axis offset(SVA),wear time of postoperative support,and the difference value between bone cement perfusion and BMD.Univariate analysis was performed on these factors,and the statistically signifificant factors were substituted into the logistic regression model to analyze their correlation with AVCF after PVP.Receiver operating characteristic(ROC)was plotted and the area under curve(AUC)was calculated to evaluate the value of dosage of bone cement infusion,BMD and difference value between bone cement perfusion and BMD in predicting AVCF after PVP.Results There were no significant differences in gender,BMI,diabetes and hypertension between the two groups(P>0.05).Univariate analysis showed that age,dosage of bone cement infusion and the difference value between bone cement perfusion and BMD in fracture group were higher than that in non-fracture group(t=7.318,8.535,7.458,P<0.05).BMD and preoperative Cobb’s Angle in fracture group were lower than those in non-fracture group(t=-6.646,-6.541,P<0.05).The rate of bone cement leakage,O-type distribution of bone cement,and non-anti-osteoporosis treatment after surgery in fracture group were higher than those in non-fracture group(χ^(2)=27.643,17.436,25.352,P<0.05).Multivariate analysis showed that BMD(95%CI:1.653-3.995,OR:2.241),bone cement perfusion(95%CI:1.743-4.635,OR:2.644),bone cement leakage(95%CI:1.249-3.016,OR:1.564),postoperative non-anti-osteoporosis treatment(95%CI:2.684-6.745,OR:3.024),and the difference between bone cement perfusion and BMD(95%CI:1.856-7.849,OR:3.656)were the independent influencing factors of AVCF after PVP.The AUC of AVCF predicted by dosage of bone cement infusion,BMD and the difference value between bone cement perfusion and BMD were 0.739(95%CI:0.560-0.918),0.772(95%CI:0.604-0.940)and 0.920(95%CI:0.920).The predicted cut-off values were-3.35,4.45 and 6.45;the sensitivity was 0.538,0.692 and 0.846;and the specificity was 0.839,0.874 and 0.785.Conclusions BMD,dosage of bone cement infusion,bone cement leakage,postoperative non-anti-osteoporosis therapy and the difference value between bone cement perfusion and BMD are risk factors for AVCF after PVP.The difference between bone cement perfusion and BMD has a good predictive value for AVCF,which can be used for clinical guidance.The difference value between bone cement perfusion and BMD has good predictive effect on the occurrence of AVCF.