椎体后凸成形术治疗骨质疏松椎体压缩骨折术后非手术椎体新发骨折的相关因素分析

Analysis on the associated factors of non-surgical vertebral fracture secondary to percutaneous kyphoplasty for osteoporotic vertebral compression fracture

中文关键词:  骨质疏松椎体压缩骨折  椎体后凸成形术  非手术椎体再骨折

英文关键词:Osteoporotic vertebral compression fracture  Percutaneous kyphoplasty  Non-surgical vertebral fracture

中文摘要:

  【摘要】 目的：探讨椎体后凸成形术治疗骨质疏松椎体压缩骨折术后非手术椎体新发骨折的相关因素。方法：回顾研究2005年1月～2009年12月我中心收治的102例行椎体后凸成形术治疗骨质疏松椎体压缩骨折患者的临床资料及随访结果，根据随访结果按有无新发椎体骨折出现将患者分成再骨折组及未骨折组（对照组），分析比较两组患者在一般情况（性别、年龄、骨密度、术前骨折椎体数目、骨折压缩程度、腰椎侧凸畸形及脊柱矢状面后凸角）、手术因素（强化椎体个数、手术入路、骨水泥量、骨水泥渗漏及椎体高度恢复程度）、外伤史、长期使用糖皮质激素史方面的差异。应用单因素方差分析及卡方检验分析诸因素与非手术椎体再骨折的相关性，将各相关因素引入Logistic回归分析,分析术后非手术椎体再骨折的主要因素。结果：所有患者均获2年以上随访，随访中共有20例患者先后出现非手术椎体再次骨折，再骨折率为19.6%，单因素分析显示骨密度、术前骨折椎体数目、手术强化椎体个数、骨折压缩程度、骨水泥渗漏及长期使用糖皮质激素史与术后非手术椎体骨折相关（P＜0.05）；而年龄、性别、外伤史、骨水泥量、椎体高度恢复程度、腰椎侧凸畸形及脊柱矢状面后凸角与术后非手术椎体骨折无明显相关（P＞0.05）。Logistic回归分析显示骨质疏松程度重（OR=0.090）、手术强化椎体数目多（OR=9.682）及长期使用糖皮质激素（OR=9.584）是术后非手术椎体再骨折的高危因素。结论：骨质疏松程度重、手术强化椎体数目多及长期使用糖皮质激素是引起术后非手术椎体新发骨折的高危因素。

英文摘要:

  【Abstract】 Objectives: To investigate the associated factors of non-surgical vertebral fracture after percutaneous kyphoplasty(PKP). Methods: The clinical data and follow-up results of 102 patients who underwent PKP due to osteoporotic vertebral compression fracture(OVCF) from January 2005 to December 2009 in our center were retrospectively studied. According to the follow-up results, the patients were divided into fracture group and non-fracture group(control group) by onset of a new fracture. The differences between the two groups in general information(sex, age, BMD, number of vertebral fractures, degree of compression, scoliosis, Cobb angle of kyphosis), operating factors(number of bone cement augmented vertebrae, approach, bone cement filling volume, bone cement leakage, restoration of vertebral height), history of trauma and long-term use of glucocorticoids were analyzed. One-way analysis of variance(ANOVA) and chi-square test were used to analyze the correlation between the above mentioned factors and non-surgical vertebral fracture. All the relevant factors were introduced to Logistic Regression Analysis to analyze the main factors of non-surgical vertebral fracture. Results: All patients were followed up for over 24 months, 20 cases suffered from a new fracture, with the fracture rate of 19.6%. ANOVA showed that bone mineral density, number of pre-existing fractured vertebrae, number of augmentation vertebrae, degree of preoperative vertebral compression, disc leakage of bone cement and long-term use of glucocorticoids were significantly related to non-surgical vertebral fracture(P＜0.05), while age, sex, injury history, volume of bone cement filling, restoration of vertebral height, scoliosis, kyphosis angle showed no relationship with onset fracture(P＞0.05). All the relevant factors logistic analysis showed severe degree of osteoporosis, more augmented vertebrae and long-term use of glucocorticoids were high risk factors associate with non-surgical vertebrae fracture, with the OR value of 0.090, 9.682, 9.584 respectively. Conclusions: A severe degree of osteoporosis, more augmented vertebras and long-term use of glucocorticoids are the high risk factors of non-surgical vertebral re-fracture secondary to percutaneous kyphoplasty.