胸腰椎骨折复位内固定术后伤椎发生骨缺损的相关危险因素分析

Risk factors analysis of bone defect after surgery of thoracolumbar fracture/

中文关键词:  胸腰椎骨折  骨缺损  相关因素分析  受试者工作特征曲线

英文关键词:Thoracolumbar fracture  Bone defects  Related factors  Receiver operating characteristic curve

中文摘要:

  【摘要】 目的：分析后入路胸腰椎骨折复位内固定术后发生骨缺损的相关危险因素。方法：回顾性分析2016年1月~2019年3月我院行后入路椎弓根钉棒系统复位内固定术治疗的胸腰椎单节段骨折的患者74例，其中男性41例，女性33例，年龄43.3±1.3（19~66）岁，术后平均随访15.6±0.2个月，术后1年完善CT检查。根据术后1年时伤椎水平位或矢状位CT图像是否出现骨缺损将患者分为骨缺损组（40例）和骨折愈合组（34例），分别记录患者的年龄、性别、体质指数（BMI）、骨折AO分型、伤椎有无置钉，并通过术前腰椎MRI评估术前椎间盘是否完整，通过CT测量术前伤椎压缩程度、术前矢状面Cobb角、伤椎撑开复位情况等相关因素，通过单因素分析和多因素Logistic回归分析研究各因素与骨缺损发生的相互关系，最后通过受试者工作特征（ROC）曲线验证各因素与骨缺损相关性的预测关系。结果：单因素分析结果显示，骨缺损组伤椎无置钉比例（27.50%）高于骨折愈合组（8.82%），术前椎间盘受损比例（35.00%）高于骨折愈合组（5.88%），伤椎过度撑开比例（52.50%）高于骨折愈合组（20.59%），术前椎体压缩程度平均（3.49±1.87）%，高于骨折愈合组的平均压缩程度（25.01±2.01）%，差异均有统计学意义（P＜0.05）。而骨缺损组与骨折愈合组之间年龄、BMI、骨折AO分型、术前矢状面Cobb角差异无统计学意义（P＞0.05）。多因素分析显示，患者术前椎间盘受损、椎体压缩严重、伤椎过度撑开是胸腰椎骨折复位术后出现骨缺损的独立危险因素。其ROC曲线下面积分别为0.660、0.706、0.646（P＜0.05），表明上述因素对术后骨缺损相关性的预测具有较好的敏感性及特异性。结论：患者术前椎间盘受损、椎体压缩严重、伤椎过度撑开是胸腰椎骨折复位术后出现骨缺损的独立危险因素。

英文摘要:

  【Abstract】 Objectives: To explore the related risk factors of bone defect after reduction and internal fixation of thoracolumbar fracture via posterior approach. Methods: Retrospective analysis of 74 patients(41 males and 33 females, aged 43.3±1.3 years) with single-segment thoracolumbar fractures treated with pedicle screw-rod system reduction and internal fixationvia posterior approach from January 2016 to March 2019 in our hospital. The mean follow-up period was 15.6±0.2 months. At 1 year after surgery, CT examination was performed. The complete preoperative and postoperative follow-up radiographic data were collected. The patients were divided into bone defect group(40 cases) and fracture healing group(34 cases) according to the presence of bone defects on the horizontal or sagittal CT images of the injured vertebra at 1 year after operation. Data of age, sex, body mass index(BMI), AO classification were recorded. Preoperative MRI was performed to evaluate the integrity condition of preoperative intervertebral disc. CT image data were used to measure the vertebral body compression before operation, sagittal cobb angle, postoperative fracture reduction status, and other related factors. Univariate analysis and multivariate logistic regression analysis were used to analyze the relationship between riskfactors and the occurrence of bone defects. The predicted relationship between the correlation of various factors and bone defects were verified through ROC curve. Results: Univariate analysis showed that the bone defect group had a higher rate of unscathed vertebral nails(27.50%) than the fracture healing group(8.82%), and the preoperative disc injury rate(35.00%) was higher than the fracture healing group(5.88%), the reduction rate (52.50%) was higher than that of fracture healing group(20.59%), the average degree of vertebral compression before operation was (3.49±1.87)%, higher than the average degree of compression of the fracture healing group (25.01±2.01)%, the difference was statistically significant(P<0.05). There was no significant difference in age, BMI, fracture AO classification, and preoperative sagittal Cobb angle between the bone defect group and fracture healing group(P>0.05). The preoperative disc injury, excessive compression of the vertebral body and excessive expansion of the fracture are independent risk factors for bone defect after thoracolumbar fracture reduction. The areas under the ROC curve were: 0.660, 0.706, 0.646(P<0.05), it suggests that the above research factors have good sensitivity and specificity for predicting the correlation of postoperative bone defects. Conclusions: The preoperative intervertebral disc integrity, preoperative vertebral body compression degree, fracture distraction status are independent risk factors for bone defects after thoracolumbar fracture reduction.