经皮穿刺椎体扩张球囊后凸成形术后邻近椎体再骨折相关危险因素分析  

Analysis of related risk factors for the refracture of adjacent vertebral body after percutaneous kyphoplasty

作　　者：方申雲 闵继康[1] 曾忠友 张强华[1] 朱涛[1] 翁伟[1] 张伟莉 沈方英[1] 夏瑛[1] 丁丽英 FANG Shen-yun;MIN Ji-kang;ZENG Zhong-you;ZHANG Qiang-hua;ZHU Tao;WENG Wei;ZHANG Wei-li;SHEN Fang-ying;XIA Ying;DING Li-ying(Orthopedics Center of Huzhou First People's Hospital,Huzhou313000,Zhejiang,China)

机构地区：[1]湖州市第一人民医院骨科中心,浙江湖州313000

出　　处：《中国骨伤》2021年第8期705-709,共5页China Journal of Orthopaedics and Traumatology

基　　金：湖州市科技局公益性一般项目(编号:2017GYB27)。

摘　　要：目的:探讨经皮穿刺椎体扩张球囊后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩骨折(osteoporosis vertebral compression fractures,OVCFs)术后椎体再骨折相关危险因素,为临床预防提供参考。方法:对2013年11月6日至2018年12月14日收治的228例符合纳入标准的OVCFs患者进行回顾性分析,男35例,女193例,年龄58~91(69.70±7.03)岁。所有患者采用PKP手术治疗且临床资料完整,按照术后是否发生再骨折分为再骨折组(24例)和未再骨折组(204例)。将可能与再骨折相关的因素(性别、年龄、手术节段、手术节段椎体数目、是否合并退行性侧弯、是否抗骨质疏松)纳入单因素研究,再将单因素分析有统计学意义的危险因素进行多元Logistic回归分析,进一步明确PKP术后椎体再骨折独立危险因素。再以PKP术后椎体再骨折时间为随访终止时间、以术后发生再骨折为终点事件,以是否合并退行性侧弯为变量因子,进行生存分析。结果:228患者均获随访,时间1.8~63.6(28.8±15.6)个月,再骨折发生率为10.5%(24/228)。两组患者在年龄、手术椎体数目、是否合并脊柱退行性侧弯、是否抗骨质疏松治疗方面差异有统计学意义(P<0.05);单因素Logistic回归分析显示手术椎体数目、合并侧弯可能为PKP术后再骨折发生的危险因素,将可能的危险因素纳入多元Logistic回归分析显示是否合并脊柱退行性侧弯是椎体再骨折的独立危险因素。生存分析时间的平均值42.1个月,P值为0.00,平均值95%置信区间为34.4-49.7个月,表明合并退行性脊柱侧弯可能与再骨折发生有关。结论:合并脊柱侧弯是OVCF椎体成形术后再骨折的独立危险因素,亦是术后发生再骨折可能的高危因素。Objective:To investigate the risk factors of vertebral refracture after percutaneous kyphoplasty(PKP)for osteoprotic vertebral compression fractures(OVCFs),and to provide reference for clinical prevention.Methods:A retrospective analysis of 228 OVCFs patients who met the inclusion criteria admitted from November 6,2013 to December 14,2018.There were 35 males and 193 females,with a male-to-female ratio of 3∶20,and aged 58 to 91 years with an average of(69.70±7.03)years.All patients were treated with PKP and had complete clinical data.According to whether refracture occurred after operation,they were divided into refracture group(24 cases)and non-refracture group(204 cases).Factors that may be related to refracture(including gender,age,surgical segment,number of vertebral bodies in the surgical segment,whether combined with degenerative scoliosis,whether anti-osteoporosis treatment)were included in the univariate analyses,and the single factor analysis of statistically significant risk factors was carried out with multiple Logistic regression analysis to further clarify the independent risk factors for vertebral body refracture after PKP.Survival analysis was performed using the time of vertebral refracture after PKP as the end time of follow-up,the occurrence of refracture after PKP as the endpoint event,and the presence or absence of degenerative lateral curvature as a variable factor.Results:All 228 patients were followed up for 1.8 to 63.6 months with an average of(28.8±15.6)months,and the refracture rate was 10.5%(24/228).There were statistically significant differences between two groups in age,number of operative vertebral bodies,whether combined with degenerative scoliosis and whether anti-osteoporosis treatment(P<0.05).Univariate Logistic regression analysis showed that the number of vertebral bodies in the surgical segment and whether combined with degenerative scoliosis may be risk factors for refracture after PKP.Multiple Logistic regression analysis of the above possible risk factors showed that co

关 键 词：椎体成形术 椎体压缩性骨折 再骨折 脊柱退行性侧弯 骨质疏松 危险因素 

分 类 号：R683.2[医药卫生—骨科学]