规律服用双膦酸盐类药物预防经皮椎体成形术后非手术椎体骨折的有效性分析

Efficacy of regular use of bisphosphonates for re-fractures prevention on non-operation levels after percutaneous vertebroplasty

目的分析骨质疏松性椎体压缩骨折经皮椎体成形术后非手术椎体骨折的影响因素,观察规律服用双膦酸盐类药物是否可以降低此类并发症发生率。方法回顾性分析自2019-01—2019-12采用经皮椎体成形术治疗的149例骨质疏松性胸腰椎压缩骨折,术后出现非手术椎体骨折的患者纳入A组,未出现非手术椎体骨折的患者纳入B组,详细记录两组性别、年龄、体质量指数、术前腰椎骨密度、骨折节段、骨折形态、骨折压缩程度、手术时间、骨水泥注入量、是否骨水泥渗漏、骨水泥弥散情况、疼痛VAS评分、是否规律服用双膦酸盐类药物,组间差异有统计学意义的因素纳入多因素Logistic回归分析。结果149例中33例术后出现非手术椎体骨折,发生率为22.1%。多因素Logistic回归分析结果显示,低骨密度[OR=0.435,95%CI(0.229,0.824),P=0.011]、低体质量指数[OR=0.762,95%CI(0.662,0.878),P<0.001]、未规律服用双膦酸盐类药物[OR=0.299,95%CI(0.098,0.916),P=0.034]是骨质疏松性椎体压缩骨折经皮椎体成形术后非手术椎体骨折的独立危险因素。结论低骨密度、低体质量指数、术后未规律服用双膦酸盐类药物是骨质疏松性椎体压缩骨折经皮椎体成形术后非手术椎体骨折发生的危险因素,临床医师需要制定针对性预防措施。相对于控制前两个危险因素,术后规律服用双膦酸盐类药物抗骨质疏松治疗更容易实现。

Objective To analyze the factors influencing non-surgical vertebral fractures following percutaneous vertebroplasty(PVP)for osteoporotic vertebral compression fractures(OVCFs)and to determine whether the regular use of bisphosphonates can reduce the incidence of such complications.Methods A retrospective analysis was conducted on 149 cases of OVCFs treated with PVP from January 2019 to December 2019.Patients who underwent postoperative non-surgical vertebral fractures were categorized into group A,while those who did not were categorized into group B.Detailed records were kept for gender,age,body mass index(BMI),preoperative lumbar bone mineral density(BMD),fracture segment,fracture morphology,degree of fracture compression,operation time,volume of cement injected,cement leakage,cement dispersion,pain VAS score,and the regular use of bisphosphonates.Factors showing significant differences between the two groups were subjected to multivariate logistic regression analysis.Results Among the 149 cases,33 experienced non-surgical vertebral fractures postoperatively,with an incidence rate of 22.1%.Multivariate logistic regression analysis identified low BMD[OR=0.435,95%CI(0.229,0.824),P=0.011],low BMI[OR=0.762,95%CI(0.662,0.878),P<0.001],and irregular use of bisphosphonates[OR=0.299,95%CI(0.098,0.916),P=0.034]as independent risk factors for non-surgical vertebral fractures following PVP for OVCFs.Conclusion Low BMD,low BMI,and irregular postoperative use of bisphosphonates are risk factors for non-surgical vertebral fractures following PVP for OVCFs.Clinicians should develop targeted preventive measures,with particular emphasis on the regular postoperative use of bisphosphonates,which is relatively easier to implement compared to controlling the first two risk factors.