夹心椎与普通邻椎再骨折风险比较及危险因素分析  

Comparison of refracture risk between sandwich vertebrae and ordinary adjacent vertebrae

作　　者：刘进[1,2] 唐静[3] 陈果 顾祖超[1] 张宇[1] 于圣会[1] 刘浩[2] LIU Jin;TANG Jing;CHEN Guo;GU Zuchao;ZHANG Yu;YU Shenghui;LIU Hao(Department of Orthopedics,Chengdu First People’s Hospital,Chengdu Sichuan,610041,P.R.China;Department of Orthopedics,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China;Department of Radiology,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China)

机构地区：[1]成都市第一人民医院骨科,成都610041 [2]四川大学华西医院骨科,成都610041 [3]四川大学华西医院放射科,成都610041

出　　处：《中国修复重建外科杂志》2021年第9期1161-1166,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：四川省卫生健康委员会科研项目(20PJ194);成都市卫生健康委员会科研项目(2020133)。

摘　　要：目的比较夹心椎与普通邻椎的再骨折风险,探讨再骨折相关危险因素。方法回顾性分析2015年4月—2019年10月采用椎体强化术治疗并形成夹心椎的患者临床资料,其中115例符合选择标准纳入研究。男27例,女88例;年龄53~89岁,平均73.9岁。单因素分析患者一般资料、椎体强化术相关指标以及夹心椎相关指标;对患者T4~L5范围内夹心椎与普通邻椎从椎体水平进行生存分析,比较夹心椎与普通邻椎再骨折风险曲线及不发生再骨折的概率,并以Cox比例风险回归模型分析再骨折危险因素。结果115例患者椎体强化术后获随访12.6~65.9个月,平均36.2个月。随访期间31例患者发生37次再骨折,累及51个椎体。夹心椎患者再骨折发生率为27.0%(31/115),高于同期所有接受椎体强化术患者(15.2%,187/1228),差异有统计学意义(χ^(2)=10.638,P=0.001)。单因素分析显示,再骨折与未再骨折患者间,除已强化椎体数量差异有统计学意义(Z=0.870,P=0.004)外,在性别、年龄、身体质量指数、有无明确致伤原因、是否行双能X线吸收测定法检测、形成夹心椎时椎体强化术式及穿刺方式、椎体强化术次数、夹心椎是否由同一次椎体强化术形成、形成夹心椎时陈旧性骨折椎体数量、是否合并脊柱畸形、骨水泥分布、夹心椎区域后凸角度方面,差异均无统计学意义(P>0.05)。在1293个非强化椎中,包含夹心椎136个、普通邻椎286个。其中,夹心椎再骨折发生率(11.3%)高于普通邻椎(6.3%)(χ^(2)=4.668,P=0.031);夹心椎1年、5年不发生再骨折的概率分别为0.90、0.87,普通邻椎分别为0.95、0.93,两者再骨折风险曲线具有统计学意义(χ^(2)=4.823,P=0.028)。Cox比例风险回归模型分析显示夹心椎、位于胸腰段的非强化椎体、已强化椎体数量多以及选择单侧穿刺是再骨折危险因素(P<0.05)。结论夹心椎具有比普通邻椎更高的再骨折风险,其1年及5年不发生再骨�Objective To compare the refracture risk between sandwich vertebrae and ordinary adjacent vertebrae,and to explore the risk factors related to refracture.Methods Retrospective analysis was performed on the data of patients who received percutaneous vertebral augmentation(PVA)and formed sandwich vertebrae between April 2015 and October 2019.Of them,115 patients were enrolled in the study.There were 27 males and 88 females with an average age of 73.9 years(range,53-89 years).Univariate analysis was performed to analyzed the patients’general data,vertebral augmentation related indexes,and sandwich vertebrae related indexes.Survival analysis was performed for all untreated vertebrae at T4-L5 of the included patients at the vertebra-specific level,and risk curves of refracture probability of untreated vertebrae between sandwich vertebrae and ordinary adjacent vertebrae were compared.Cox’s proportional hazards regression model was used to analyze risk factors for refracture.Results The 115 patients were followed up 12.6-65.9 months(mean,36.2 months).Thirty-seven refractures involving 51 vertebral bodies occurred in 31 patients.The refracture rate of 27.0%(31/115)in patients with sandwich vertebrae was significantly higher than that of 15.2%(187/1228)in all patients who received PVA during the same period(χ^(2)=10.638,P=0.001).Univariate analysis results showed that there was a significant difference in the number of augmented vertebrae between patients with and without refractures(Z=0.870,P=0.004).However,there was no significant difference in gender,age,body mass index,whether had clear causes of fracture,whether had dual energy X-ray absorptiometry testing,whether the sandwich vertebra generated through the same PVA,puncture method,method of PVA,number of PVA procedures,number of vertebrae with old fracture,whether complicated with spinal deformity,bone cement distribution,and kyphosis angle of sandwich vertebral area(P>0.05).Among the 1293 untreated vertebrae,there were 136 sandwich vertebrae and 286 ordinary a

关 键 词：骨质疏松性椎体压缩骨折 夹心椎 再骨折 COX比例风险回归模型 椎体强化 

分 类 号：R687.3[医药卫生—骨科学]