单节段胸腰椎骨质疏松性骨折经皮椎体后凸成形术后其他椎体新发骨折的影响因素分析

Analysis of the influencing factors of new fractures of other vertebrae after percutaneous kyphoplasty for single-level thoracolumbar osteoporotic vertebral compression fractures

中文关键词:  骨质疏松性椎体压缩骨折  经皮椎体后凸成形术  其他椎体骨折  再骨折  影响因素

英文关键词:Osteoporotic vertebral compression fractures  Percutaneous kyphoplasty  Other vertebral fractures  Refracture  Influencing factors

中文摘要:

  【摘要】 目的：分析单节段胸腰椎骨质疏松性压缩骨折患者经皮椎体后凸成形术（percutaneous kyphoplasty，PKP）后其他椎体（非手术椎体）新发骨折的影响因素。方法：回顾性分析2018年1月～2019年12月在我院行PKP手术的258例单节段胸腰椎骨质疏松性压缩骨折患者的资料。其中男35例，女223例；年龄49～92岁（70.3±9.3岁）。骨折节段：T6～T8 9例，T9～T11 33例，T12～L2 180例，L3～L5 36例。随访24～48个月（36.4±6.7个月），根据末次随访时是否出现其他椎体新发骨折将患者分为再骨折组和非再骨折组，比较两组患者性别、年龄、伤椎节段、有无糖尿病、术前骨密度（BMD）、术前血钙和血磷、白蛋白值、是否合并脊柱侧凸、骨水泥注入量、是否有骨水泥渗漏、术后是否规范抗骨质疏松治疗等临床及影像学资料，将具有统计学差异的参数进行多因素Logistic回归分析。结果：258例患者中，末次随访时有21例（8.14%）出现了其他椎体新发骨折（再骨折组），237例未发生再骨折（非再骨折组）。再骨折患者中，18例（85.71%）仍为单节段骨折，再骨折节段位于胸段（T10及以上）8例（38.10%），胸腰段（T11～L2）7例（33.33%），腰段（L3及以下）3例（14.29%）；3例（14.29%）为两个节段骨折。两组患者性别、年龄、伤椎节段、有无糖尿病、术前BMD、术前血钙和血磷、白蛋白值、骨水泥注入量、术后是否规范抗骨质疏松治疗均无统计学差异（P>0.05），是否合并脊柱侧凸、是否有骨水泥渗漏有统计学差异（P<0.05）。Logistic回归分析结果表明，合并脊柱侧凸[比值比（odds ratio，OR）=1.135，95%置信区间（confidence interval，CI）为1.005～1.296，P=0.015]与骨水泥渗漏（OR=1.258，95%CI为1.085～1.727，P=0.023）是PKP术后其他椎体新发骨折的危险因素。结论：单节段胸腰椎骨质疏松性压缩骨折患者合并脊柱侧凸或存在骨水泥渗漏易在PKP术后发生其他椎体新发骨折。

英文摘要:

  【Abstract】 Objectives: To analyze the influencing factors of new fractures of other vertebral bodies(non-operative) after percutaneous kyphoplasty(PKP) in patients with single-level thoracolumbar osteoporotic vertebral compression fractures(OVCFs). Methods: The data of a total of 258 patients with single-level thoracolumbar OVCFs who underwent PKP in our hospital from January 2018 to December 2019 were retrospectively analyzed. There were 35 males and 223 females. The age of the patients ranged from 49 to 92 years(70.3±9.3 years). The fracture segments were: T6-T8 in 9 cases, T9-T11 in 33 cases, T12-L2 in 180 cases, and L3-L5 in 36 cases. The patients were followed up for 36.4±6.7 months(24-48 months) and they were divided into refracture group and non-refracture group according to whether presenting with new fractures of other vertebral bodies at the last follow-up. The clinical and imaging data such as gender, age, injured vertebral segment, with or without diabetes mellitus, preoperative bone mineral density(BMD), preoperative blood calcium, blood phosphorus, albumin, with or without scoliosis, bone cement injection volume, whether presenting with bone cement leakage, and standardized postoperative anti-osteoporosis treatment were analyzed and compared between the two groups. The parameters with statistical differences were analyzed by multivariate Logistic regression. Results: Among the 258 patients, 21 patients(8.14%) had new fracture of other vertebral bodies(refracture group) and 237 patients did not have refracture(non-refracture group) at the last follow-up. 18 cases(85.71%) in the refracture group were still single-segment fractures, involving thoracic(T10 and above) in 8 cases(38.10%), thoracolumbar(T11-L2) in 7 cases(33.33%) , and lumbar(L3 and below) in 3 cases(14.29%), and the other 3 cases(14.29%) were two-segment fractures. There was no significant difference in gender, age, injured vertebral segment, with or without diabetes mellitus, preoperative BMD, preoperative blood calcium, blood phosphorus, albumin, bone cement injection volume, and with or without standardized postoperative anti-osteoporosis treatment between the two groups(P>0.05). Significant differences were noticed in whether with scoliosis and presenting with bone cement leakage(P<0.05). Logistic regression analysis showed that scoliosis[odds ratio(OR)=1.135, 95% confidence interval(CI) 1.005-1.296, P=0.015] and bone cement leakage(OR=1.258, 95%CI 1.085-1.727, P=0.023) were the risk factors for new fractures of other vertebrae after PKP. Conclusions: Patients with single segment thoracolumbar osteoporotic compression fracture combined with scoliosis or bone cement leakage are prone to develop new fractures of other vertebrae after PKP.