椎体后凸成形术后非手术椎体再发骨折的相关因素分析

摘要

目的 探讨骨质疏松性椎体压缩性骨折(Osteoporotic vertebral compression fractures,OVCF)行经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗后,非手术椎体再发骨折的相关因素.方法 回顾性分析152例行PKP治疗的OVCF患者,其中39例术后非手术椎体再发骨折(再发骨折组),另113例无再发骨折(对照组).对比两组患者的年龄、性别、体重指数、骨密度值、单/双侧注射、骨水泥分布情况以及抗骨质疏松治疗时间、术后支具佩戴时间等各项指标,并进行多因素的Logistic回归分析.结果 152例患者PKP术后均获得随访,随访18-26个月左右.术后非手术椎体再发骨折共39例,包括相邻椎体骨折27例,非相邻椎体骨折12例,发生率为25.7％.单因素分析显示,与再骨折组相比,对照组体重指数明显偏高,骨密度值较高,支具佩戴时间、抗骨质疏松治疗时间更长,上终板所在的骨水泥存在椎间盘渗漏率、骨水泥与上终板接触率更低(均为P＜0.05).Logistic回归分析显示,骨密度值过低(OR=3.968,P=0.002)、上终板骨水泥的椎间盘渗漏和骨水泥与上终板接触率高(OR=4.635,P=0.001),均是导致术后再发非手术椎体骨折的危险因素;而较高的体重指数(OR=0.253,P=0.015),抗骨质疏松治疗时间长(OR=0.546,P=0.017)以及支具佩戴时间长(OR=0.528,P=0.003)均是避免术后再发骨折的保护因素.结论 OVCF患者行PKP术后,规范化抗骨质疏松治疗,术后佩戴腰围支具,可能降低再骨折的风险.骨密度偏低、术后骨水泥渗漏至椎间盘或接触终板的患者,是非手术椎体再骨折的危险因素.%Objective To investigate the related factors of non-operative vertebral body refracture in osteoporotic vertebral compression fractures (OVCF) patients underwent percutaneous kyphoplasty (PKP) treatment.Methods 152 cases of OVCF treated by PKP were retrospectively analyzed,including 39 cases of non-operative vertebral refracture (refracture group) and 113 patients without recurrence of fracture(control group).The age,sex,body mass index,bone mineral density,single/bilateral injection,bone cement distribution and time,treatment of anti-osteoporosis after brace time and other indicators were compared in two groups,Logistic regression analysis and multiple factors were conducted.Results 152 PKP patients were followed up for 18-26 months.There were 39cases of non-operative vertebral fractures,27 cases of adjacent vertebral fractures,12 cases of nonadjacent vertebral fractures,the incidence rate was 25.7％.Univariate analysis showed that compared with the fracture group,the control group showed significantly higher body mass index,the higher value of bone mineral density,brace,anti-osteoporosis treatment time was longer,bone cement on the endplate of intervertebral disc and bone cement leakage rate in contact with the upper endplate was lower (P＜0.05).Logistic regression analysis showed that the bone density was too low (OR=3.968,P=0.002),the upper endplate of intervertebral disc and bone cement leakage of bone cement and the endplate with high contact ratio (OR=4.635,P=0.001),which were the risk factors leading to postoperative recurrence of non-surgical vertebral fractures.And higher body mass index (OR=0.253,P=0.015),anti-osteoporosis treatment for a long time (OR=0.546,P=0.017) and a brace to wear for a long time(OR=0.528,P=0.003) were protective factors to avoid the recurrence of fracture.Conclusion OVCF patients with PKP after operation,standardized anti-osteoporosis treatment,postoperative wear waist brace,may reduce the risk of refracture.Low bone density,bone cement leakage to the intervertebral disc or contact end plate of the patients are the risk factors for non-surgical vertebral refracture.