椎旁肌肉减少与经皮椎体后凸成形术后邻近节段再骨折的相关性分析

The relationship between paraspinal sarcopenia and adjacent segment refracture after percutaneous kyphoplasty

中文关键词:  邻近节段椎体压缩性骨折  肌少症  经皮后凸成形术  危险因素

英文关键词:Adjacent vertebral compression fracture  Sarcopenia  Percutaneous kyphoplasty  Risk factor

中文摘要:

  【摘要】 目的：探讨椎旁肌肉减少与经皮椎体后凸成形术（percutaneous kyphoplasty，PKP）治疗骨质疏松压缩性骨折（osteoporotic vertebral compression fracture，OVCF）术后邻近节段椎体压缩性骨折（adjacent vertebral compression fracture，AVCF）之间的相关性。方法：收集2017年1月~2019年12月在我院接受PKP治疗1年内发生AVCF的OVCF患者的272例患者资料，符合纳入和排除标准的42例患者被选为AVCF组，对照组为同一时期在我院接受PKP治疗1年内未发生AVCF的OVCF患者，根据年龄、性别、体质指数（body mass index，BMI）和首次PKP治疗的节段，与AVCF组中的每例患者进行严格的倾向性评分匹配。两组患者术前进行腰椎MRI检查，在MRI上测量L3和L4水平椎旁肌（paravertebral muscle，PVM）[多裂肌 （multifidus，MF）、竖脊肌（erector spinae，ES）、腰大肌（psoas，PS）]总横截面积（cross-sectional area，CSA）和功能横截面积 （functional cross-sectional area，FCSA），计算CSA椎体指数、FCSA椎体指数。在矢状位重建CT图像上获取L5 CT值为术前椎体的骨密度（bone mineral density，BMD）；在X线片上测量后凸角（kyphotic angle，KA）、椎体前后壁高度（anterior-to-posterior body height，AP）比值，记录有无骨水泥渗漏入椎间盘等。采用t检验、ROC曲线分析、Delong检验和多因素Logistic回归分析，寻找PKP术后AVCF的独立危险因素。结果：在L3和L4水平，AVCF组MF、ES、PVM和PS 的平均CSA、FCSA及FCSA椎体指数均小于对照组，差异有统计学意义（P＜0.05）。Delong检验显示L4水平ES（0.806 vs 0.900）和PVM（0.861 vs 0.941）的FCSA椎体指数对于预测AVCF的AUC大于L3水平，差异有统计学意义（P＜0.05）。ROC曲线分析显示L4水平PVM的FCSA椎体指数，其AUC为0.941（P<0.001），敏感性和特异性均为 90.5%。单因素分析显示AVCF组中患者BMD低于对照组 （93.55±14.99HU vs 106.31±10.95HU）；术前后凸角大于对照组（16.02°±17.36° vs 12.87°±6.58°），差异有统计学意义（P＜0.05）。Logistic回归分析显示，L4水平PVM的FCSA椎体指数减少（OR 0.830；95%CI 0.760~0.906）和BMD降低（OR 0.928；95%CI 0.891~0.966）是PKP术后AVCF的独立危险因素。结论：L4椎旁肌肉减少是OVCF患者PKP术后AVCF的独立危险因素。

英文摘要:

  【Abstract】 Objectives: To investigate the association between paravertebral sarcopenia and adjacent vertebral compression fracture(AVCF) after percutaneous kyphoplasty(PKP) for osteoporotic vertebral compression fracture(OVCF). Methods: Data were retrospectively collected from 272 OVCF patients who had AVCF within 1 year after receiving PKP at our hospital from January 2017 to December 2019. 42 patients who met the inclusion and exclusion criteria were selected as the AVCF group, and the control group was composed of OVCF patients who did not have AVCF within 1 year after PKP only at our hospital during the same period. Each patient in the AVCF group was matched to a strict propensity score based on age, gender, body mass index(BMI), and the first segment of PKP treatment. Preoperative MRI of the lumbar spine was performed in both groups, and the total cross-sectional area(CSA) and functional cross-sectional area(FCSA) of paravertebral muscles(PVM) at L3 and L4[multifidus(MF), erector spinae(ES), psoas(PS)] were measured on MRI. The CSA vertebra index(CSA-VI) and FCSA vertebra index(FCSA-VI) were calculated. The L5 CT values were obtained on the sagittal reconstructed CT images as the preoperative bone mineral density(BMD); the kyphotic angle (KA) and anterior-to-posterior body height ratio(AP ratio) were measured on the radiographs, and the leakage of bone cement into the intervertebral disc was recorded. The t-test, Delong, ROC analysis and multi-factor Logistic regression analysis were used to find independent risk factors for AVCF after PKP. Results: The mean CSA, FCSA, and FCSA-VI of MF, ES, PVM, and PS were smaller in the AVCF group than in the control group at the L3 and L4 levels, with statistically significant differences(P<0.05). The DeLong test showed that the FCSA-VI of ES(0.806 vs 0.900) and PVM(0.861 vs 0.941) at the L4 level in predicting AVCF AUC was greater than that of L3 level, and the difference was statistically significant(P<0.05). ROC analysis showed that FCSA-VI of PVM at L4 level had an AUC of 0.941(P<0.001) with a sensitivity and specificity of 90.5%. Univariate analysis showed that BMD was lower in the AVCF group than in the control group (93.55±14.99HU vs 106.31±10.95HU); the preoperative KA was greater than in the control group(16.02°±17.36° vs 12.87°±6.58°), with a statistically significant difference(P<0.05). Logistic regression analysis showed the decrease in FCSA-VI at the L4 level of PVM(OR 0.830; 95%CI 0.760-0.906) and reduced BMD(OR 0.928; 95%CI 0.891-0.966) were the independent risk facors of AVCF after PKP. Conclusions: Paraspinal sarcopenia at L4 is an independent risk factor for AVCF after PKP in OVCF patients.