椎旁肌退变对胸腰段OVCF患者术后再发邻椎骨折的影响:基于严格的倾向性匹配分析

The impact of paravertebral muscle degeneration on postoperative recurrence of adjacent vertebral fractures in OVCF patients:based on rigorous propensity matching analysis

目的 采用严格的倾向性匹配分析方法,对椎旁肌退变与胸腰段骨质疏松性椎体压缩骨折(OVCF)患者PKP术后再发邻椎骨折(AVF)的相关性进行论证。方法 以该院2019年1月~2022年1月行PKP手术、术后1年内再发AVF的40例胸腰段OVCF患者作为研究对象,纳入AVF组;同时,采用严格的倾向性匹配分析方法,根据AVF组患者年龄、性别、体质量指数和OVCF骨折部位,按照1:1的比例随机匹配获取同时期行PKP手术、术后1年内未再发AVF的40例OVCF患者作为对照组。所有患者均于术前行腰椎MRI检查,以平行于椎体终板作为扫描平面,分别于L3、L4椎体的下终板平面测量腰大肌、竖脊肌、多裂肌和椎旁肌的横截面积(CSA)以及功能横截面积(FCSA);此外,测量患者术前椎体骨密度和椎体后凸角(KA)、椎体前壁和后壁的比值(AP)。对两组患者的上述指标进行比较,并利用Delong检验对AVF组患者MRI检查L3水平和L4水平测得的竖脊肌、多裂肌和腰大肌CSA、FCSA进行比较,通过ROC曲线分析得出具有AVF潜在预测价值的相关指标;通过Logistic回归模型,将各项指标进行多元回归分析,以验证椎旁肌退变对AVF的独立影响。结果 AVF组患者L3和L4水平的多裂肌、竖脊肌、腰大肌和椎旁肌的CSA值、FCSA值,均显著低于对照组(P<0.05)。Delong检验和ROC曲线分析显示,L4水平的椎旁肌FCSA是AVF的潜在预测指标。AVF组的伤椎KA角显著大于对照组、骨密度值显著低于对照组(P<0.05);两组患者的伤椎AP值、骨水泥渗漏、合并症情况比较,均不存在统计学差异(P>0.05)。Logistic回归模型分析得出:骨密度值(β=-0.069;OR=0.915)和L4水平椎旁肌FCSA(β=-0.263;OR=0.816),均是OVCF患者行PKP手术后发生AVF独立风险因素。结论 椎旁肌退变是PKP术后AVF的一项独立预测因素,对于胸腰段OVCF患者不仅要重视规律的长期抗骨质疏松治疗,还应鼓励其进行椎旁肌功能训练,有助于降低术后AVF的发生风险。

Objective To demonstrate the correlation between paravertebral muscle degeneration and recurrent adjacent vertebral fractures(AVF)in patients with osteoporotic vertebral compression fractures(OVCF)after PKP using a rigorous propensity matching analysis method.Method Forty OVCF patients who underwent PKP surgery in our hospital from January 2019 to January 2022 and experienced recurrent AVF within one year after surgery were selected as the study subjects and included in the AVF group;At the same time,a strict propensity matching analysis method was used to randomly match 40 OVCF patients who underwent PKP surgery at the same time and did not experience AVF within 1 year after surgery in a 1∶1 ratio based on age,gender,body mass index,and OVCF fracture site in the AVF group as the control group.All patients underwent lumbar MRI examination before surgery,with the scanning plane parallel to the vertebral endplate.The cross-sectional area(CSA)and functional cross-sectional area(FCSA)of the psoas major,erector spinalis,multifidus,and paraspinal muscles were measured at the lower endplate planes of the L3 and L4 vertebral bodies,respectively;In addition,preoperative vertebral bone density and kyphosis angle(KA),as well as the ratio of anterior and posterior vertebral walls(AP),were measured in patients.The above indicators were compared between the two groups of patients,and the CSA and FCSA of the erector spinae,multifidus and psoas major muscles measured at the L3 level and L4 level of MRI examination in the patients in the AVF group were compared using Delong′s test,so that the relevant indicators with potential predictive value of AVF were derived through ROC curve analysis;the indicators were subjected to multivariate regression analysis through the Logistic regression model to verify the independent effect of paravertebral muscle degeneration on AVF.Results The CSA and FCSA values of the multifidus,erector spinalis,psoas major,and paraspinal muscles at L3 and L4 levels in the AVF group were significantly lower than those in the control group(P<0.05).Delong test and ROC curve analysis showed that the L4 level of paravertebral muscle FCSA was a potential predictive indicator of AVF.The KA angle of the AVF group was significantly higher than that of the control group,and the bone density value was significantly lower than that of the control group(P<0.05);There was no statistically significant difference in the AP value,bone cement leakage,and comorbidities between the two groups of patients(P>0.05).Logistic regression model analysis showed that bone density values(β=-0.069;OR=0.915)and L4 level paravertebral muscle FCSA(β=-0.263;OR=0.816),both were independent risk factors for AVF in OVCF patients undergoing PKP surgery.Conclusion Paravertebral muscle degeneration is an independent predictor of postoperative AVF after PKP,and patients with OVCF should not only be emphasized on regular long-term anti-osteoporosis treatment,but also be encouraged to undergo paraspinal muscle functional training,which can help reduce the risk of postoperative AVF.