骨质疏松性椎体压缩骨折椎体成形术后发生邻近椎体骨折的危险因素分析

Analysis of risk factors for adjacent vertebral fractures after percutaneous vertebroplasty for osteoporotic vertebral compression fractures

中文关键词:  骨质疏松性椎体压缩性骨折  邻近椎体骨折  上终板骨折  经皮椎体成形术  危险因素

英文关键词:Osteoporotic vertebral compression fracture  Adjacent vertebral fracture  Superior endplate fracture  Percutaneous vertebroplasty  Risk factors

中文摘要:

  【摘要】 目的：评估骨质疏松性椎体压缩性骨折（osteoporotic vertebral compression fracture，OVCF）患者经皮椎体成形术（percutaneous vertebroplasty，PVP）治疗后邻近椎体骨折（adjacent vertebral fracture，AVF）的发生率和危险因素。方法：回顾性分析2017年6月~2022年1月在同济大学附属东方医院接受PVP治疗的482例OVCF患者，其中男性146例，女性336例，年龄68.4±3.1岁（63~86岁），随访时间42.9±10.2个月（24~70个月）。根据随访期间是否发生AVF将患者分为AVF组和非AVF组，并记录AVF发生时间，通过Kaplan-Meier法计算患者AVF发生率并获得生存曲线。比较两组患者临床因素，包括性别、年龄、体质指数（body mass index，BMI）、邻椎CT值、骨代谢相关检验指标[总Ⅰ型前胶原氨基端延长肽（total procollagen type Ⅰ N-terminal propeptide，tPⅠNP）、β-Ⅰ型胶原羧基端肽（β-cross-linked C-telopeptide of type Ⅰ collagen，β-CTX）、25-羟基维生素D（25-hydroxyvitamin D，25-OHD）]；影像学因素，包括骨折是否位于胸腰段、是否伴有上终板骨折、是否伴有椎体内真空裂隙征（intravertebral vacuum cleft，IVC）、术前椎体高度、楔形角、后凸角；手术因素，包括骨水泥注入量、术后椎体高度恢复、楔形角恢复、后凸角恢复、是否有骨水泥渗漏等。将单因素分析有意义的指标进行多因素Logistic回归分析。结果：47例（9.75%）患者PVP后发生AVF，AVF发生在PVP后17.9±14.7个月（1~55个月）。Kaplan-Meier生存曲线显示上终板骨折组AVF发生率显著高于无上终板骨折组（P<0.001）。AVF组与非AVF组患者在性别、BMI、tPⅠNP、β-CTX、25-OHD、术前椎体高度、楔形角、后凸角、骨水泥注入量、术后椎体高度恢复、楔形角恢复、后凸角恢复均无统计学差异（P>0.05），年龄、邻椎CT值、骨折是否位于胸腰段、是否伴有上终板骨折、是否伴有IVC和是否伴有骨水泥渗漏具有统计学差异（P<0.05）。进一步多因素Logistic回归分析结果表明，高龄（OR=1.187，95%CI=1.084~1.300，P<0.001）、邻椎CT值低（OR=0.928，95%CI=0.892~0.964，P<0.001）、伴有上终板骨折（OR=3.514，95%CI=1.444~8.551，P=0.006）、伴有IVC（OR=2.804,95%CI=1.238~6.349，P=0.013）和骨水泥渗漏（OR=2.415，95%CI=1.134~5.146，P=0.022）是PVP术后发生AVF的危险因素。结论：高龄、邻椎CT值低、伴有上终板骨折、伴有IVC和骨水泥渗漏是OVCF患者PVP术后发生AVF的独立危险因素。

英文摘要:

  【Abstract】 Objectives: To explore the incidence and risk factors of adjacent vertebral fractures(AVF) in patients with osteoporotic vertebral compression fractures(OVCF) after percutaneous vertebroplasty(PVP) treatment. Methods: A retrospective analysis was conducted on 482 OVCF patients who underwent PVP at our hospital from June 2017 to January 2022. There were 146 males and 336 females, with an average age of 68.4±3.1 years(63-86 years). The average follow-up time was 42.9±10.2 months(24-70 months). Based on whether AVF occurred during the follow-up period, the patients were divided into an AVF group and a non-AVF group. The time of AVF occurrence was recorded, and the incidence rate of AVF was calculated using the Kaplan-Meier method to obtain a survival curve. Intergroup comparisons were made in terms of clinical factors including gender, age, body mass index(BMI), adjacent vertebral CT value, and bone metabolism related indexes[total procollagen type Ⅰ N-terminal propeptide(tPⅠNP), β-cross-linked C-telopeptide of type Ⅰ collagen(β-CTX), and 25-hydroxyvitamin D(25-OHD)]; Imaging factors such as whether the fracture was located in the thoracolumbar segment, whether it was accompanied by an upper endplate fracture, whether it was accompanied by an intravertebral vacuum cleft(IVC), preoperative vertebral body height, wedge angle, and kyphosis angle; And surgical factors including bone cement injection volume, postoperative restoration of vertebral height, restoration of wedge angle, restoration of kyphosis angle and whether bone cement leakage occurred. Indicators that were significant in the univariate analysis were included in the multivariate logistic regression analysis. Results: AVF occurred in 47 cases(9.75%) in 17.9±14.7 months(1-55 months) after PVP. The Kaplan-Meier survival curve showed that the incidence of AVF in the group with upper endplate fractures was significantly higher than that in the group without upper endplate fractures(P<0.001). There were no statistically significant differences between the AVF group and the non-AVF group in terms of gender, BMI, tPⅠNP, β-CTX, 25-OHD, preoperative vertebral body height, wedge angle, kyphosis angle, bone cement injection volume, postoperative restoration of vertebral height, restoration of wedge angle and restoration of kyphosis angle(P>0.05). Statistically significant differences were found in age, adjacent vertebral CT value, whether the fracture was located in the thoracolumbar segment, whether it was accompanied by an upper endplate fracture, whether it was accompanied by an IVC, and whether bone cement leakage occurred(P<0.05). Further multivariate logistic regression analysis showed that advanced age(OR=1.187, 95%CI=1.084-1.300, P<0.001), low CT value of adjacent vertebra(OR=0.928, 95%CI=0.892-0.964, P<0.001), presence of upper endplate fracture(OR=3.514, 95% CI=1.444-8.551, P=0.006), presence of IVC(OR=2.804, 95%CI=1.238-6.349, P=0.013), and bone cement leakage(OR=2.415, 95%CI=1.134-5.146, P=0.022) were the risk factors for AVF after PVP. Conclusions: Advanced age, low CT value of adjacent vertebra, upper endplate fracture, IVC, and bone cement leakage are the independent risk factors for postoperative AVF in OVCF patients undergoing PVP.