骨水泥椎体强化术后椎体再塌陷的危险因素分析

Risk factor analysis for recollapse of cemented vertebrae after percutaneous augmentation

中文关键词:  椎体强化术  骨质疏松性椎体压缩骨折  再塌陷

英文关键词:Vertebral augmentation  Osteoporotic vertebral compression fracture  Recollapse

中文摘要:

  【摘要】 目的：探讨骨质疏松性椎体压缩骨折经皮骨水泥椎体强化术后椎体再塌陷的危险因素。方法：对2012年1月~2014年6月收治的304例单节段骨质疏松性椎体压缩骨折行椎体强化术患者的临床资料进行回顾性分析，包括患者的情况（年龄、性别、体重指数、腰椎骨密度、胸腰段骨折、是否存在椎体内骨坏死等）、手术因素（手术方式、骨水泥量、骨水泥呈团块样分布还是均匀弥散样分布、骨折线区域骨水泥填充是否足够等），并记录患者术后第3天、末次随访时局部Cobb角及骨水泥再塌陷例数。将上述指标作为可能相关的因素纳入单因素研究，并通过多因素Logistic回归分析得出椎体强化术后骨水泥椎体再塌陷的相关危险因素。结果：304例单节段骨质疏松性椎体压缩骨折患者均顺利完成手术，手术时间35~50min，平均41.0±3.5min。240例患者获得随访，随访时间为1~4年，平均2.6±1.1年，随访期间共有30例患者出现骨水泥椎体再塌陷，再塌陷率达12.5%。单因素分析显示，骨密度、骨水泥剂量、椎体内骨坏死、骨水泥呈团块样分布、骨折线区域骨水泥填充不足是术后骨水泥椎体再塌陷的潜在危险因素（P<0.05），而患者性别、年龄、体重指数、手术方式等在两组间的差异不具有统计学意义（P>0.05）。多因素分析结果显示，术前存在椎体内骨坏死、骨水泥呈团块样分布、骨折线区域骨水泥填充不足是术后骨水泥椎体再塌陷的危险因素（P<0.05）。结论：术前存在椎体内骨坏死、骨水泥呈团块样分布、骨折线区域骨水泥填充不足可能是椎体强化术后骨水泥椎体发生再塌陷的独立危险因素。

英文摘要:

  【Abstract】 Objectives: To analyze the risk factors for recollapse of cemented vertebrae after percutaneous augmentation in patients with osteoporotic vertebral compression fractures(OVCFs). Methods: From January 2012 to June 2014, 304 cases of single segmental OVCFs were retrospectively reviewed. The following covariates: age, gender, body mass index(BMI), bone mineral density(BMD), thoracolumbar fracture, preoperative osteonecrosis were recorded. The surgical variables were as follows: operation approach, injected cement volume, cement distribution pattern(solid lump pattern or interdigitation pattern), cement filling around fracture line area. Cobb angles of treated vertebrae at 3d post-operation and the final follow-up, and recollapsed vertebrae numbers were assessed. Furtherly, an one-way analysis of variance with those parameters and binary logistic regression analysis was made to determine the relative risk factors. Results: 3304 patients had operation successfully. The average operation time was 41.0±3.5 minutes(range, 35 minutes to 50 minutes). 240 patients were evaluated with a mean of 2.6±1.1 years follow-up(range, 1-4 year). 30 cemented vertebrae were identified with recollapse(12.5%), 23 of them occurred in thoracolumbar area. According to one-way analysis, low BMD, small amount of cement injected, preoperative osteonecrosis, solid lump cement pattern, and insufficient cement distributing around fracture line area were analyzed as potential risk factors(P<0.05), while the differences of gender, age, BMI, operation approach impacted the recollapse without significance(P>0.05). Furthemore, preoperative osteonecrosis existing, solid lump cement pattern, and insufficient cement distributing around fracture line area were determined as risk factors by binary logistic regression analysis(P<0.05). Conclusions: The recollapse of cemented vertebrae occurrs in 12.5% of single-level OVCFs after augmentation. Preoperative osteonecrosis, solid lump pattern, and insufficient cement distributing around fracture line area probably increase the risk.