骨质疏松性椎体骨折患者PKP术后邻近椎体骨折和骨水泥松动的因素

Imaging factors of adjacent vertebral fractures and loosening of bone cement after balloon kyphoplasty in patients with osteoporotic vertebral fractures

目的探讨骨质疏松性椎体压缩性骨折(osteoporotic vertebral compression fractures,OVCF)患者PKP术后邻近椎体骨折(adjacent vertebral fractures,AVF)和骨水泥松动(cement loosening,CL)的影像学因素。方法选择2018年1月~2020年12月在本院接受PKP治疗的OVCF患者193例,收集患者临床资料和影像学资料[冠状位Cobb角、矢状垂直轴(sagittal vertical axis,SVA)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)、伤椎楔形角、局部后凸角、楔形角矫正度、局部后凸角矫正度],观察影响AVF和CL的独立风险因素。结果PKP术后AVF发生41例(21.24%)。AVF组患者伴退行性脊柱侧凸的占比、SVA、PT、局部后凸角、局部后凸角矫正度、楔形角矫正度均高于非AVF患者,SS低于非AVF患者,差异均有统计学意义(P<0.05)。AVF组患者年龄、骨水泥用量高于非AVF患者,骨密度低于非AVF患者,差异均有统计学意义(P<0.05)。PKP术后CL发生率为9.84%。CL组患者退行性脊柱侧凸的占比、SVA、PT、局部后凸角、楔形角、局部后凸角矫正度、楔形角矫正度、棘突骨折的占比均高于非CL组患者,SS低于非CL组患者(P<0.05)。多因素分析显示,年龄≥75岁、退行性脊柱侧凸、局部后凸角是PKP术后AVF的风险因素(P<0.05);年龄、棘突骨折是PKP术后CL的风险因素(P<0.05)。结论退行性脊柱侧凸、局部后凸角等影像学特征是PKP术后AVF的风险因素,棘突骨折是CL的风险因素。

Objective To study the imaging factors of adjacent vertebral fractures(AVF)and cement loosening(CL)after balloon kyphoplasty(PKP)in patients with osteoporotic vertebral compression fractures(OVCF).Methods A total of 193 patients with OVCF who received PKP treatment in our hospital from January 2018 to December 2020 were selected as the research objects,and the clinical and imaging data[coronal Cobb angle,sagittal vertical axis(SVA),pelvic incidence angle(PI),pelvic tilt angle(PT),sacral slope angle(SS),wedge angle,local kyphosis angle,wedge angle correction,local kyphosis angle correction]were collected.Independent risk factors affecting AVF and CL were observed.Results AVF occurred in 41 cases(21.24%)after PKP.In the AVF group,the degenerative scoliosis,SVA,PT,local kyphosis angle,local kyphosis angle change,local kyphosis angle correction and wedge angle correction were all higher than those in the non AVF group,and SS was lower than that in the non AVF group(P<0.05).The age and bone cement dosage of patients in AVF group were higher than those in non AVF patients,and the bone mineral density and bisphosphonate dosage were lower than those in non AVF patients(P<0.05).The incidence of CL was 9.84%.The degenerative scoliosis,SVA,PT,local kyphosis angle,wedge angle,position local kyphosis angle change,position wedge angle change,local kyphosis angle correction,wedge angle correction and spinous process fracture in CL group were higher than those in non CL group,and SS was lower than that in non CL group(P<0.05).Multivariate analysis showed that age≥75 years,degenerative scoliosis and local kyphosis angle were risk factors for AVF(P<0.05),and age and spinous process fracture were risk factors for CL(P<0.05).Conclusion The imaging features of degenerative scoliosis,local kyphosis angle and spinous process fracture are the risk factors of AVF after PKP,and spinous process fracture is the risk factor of CL.