椎体后凸成形注射自固化磷酸钙骨水泥后高龄及应力改变为再发骨折的危险因素  

Risk factors of recurrent fracture after injection of calcium phosphate cement in kyphoplasty:advanced age and stress change

作　　者：李杨 杜怡斌 刘艺明 李凡杰 Li Yang;Du Yibin;Liu Yiming;Li Fanjie(Department of Spine Surgery,Third Affiliated Hospital of Anhui Medical University,Hefei 230061,Anhui Province,China)

机构地区：[1]安徽医科大学第三附属医院脊柱外科,安徽省合肥市230061

出　　处：《中国组织工程研究》2022年第28期4507-4513,共7页Chinese Journal of Tissue Engineering Research

基　　金：合肥市卫健委应用医学研究项目基金资助(2019001),项目负责人:杜怡斌。

摘　　要：背景:现今对经皮椎体后凸成形注射自固化磷酸钙骨水泥后再发椎体骨折的可能危险因素和发病机制尚存争议,主要观点集中在与患者自身临床特点和手术相关因素有关。目的:探讨老年骨质疏松性椎体压缩骨折行经皮椎体后凸成形注射自固化磷酸钙骨水泥后再发骨折的相关危险因素。方法:回顾性分析安徽医科大学第三附属医院2016年2月至2018年2月收治的162例(共191个椎体)骨质疏松性椎体压缩骨折患者的病历资料,年龄51-88岁,均进行椎体后凸成形注射自固化磷酸钙骨水泥治疗。术后均随访2年以上,术后再发骨折34例(共44个椎体),以未发生再骨折者128例为对照组(共147个椎体),比较两组之间的年龄、性别比例、骨水泥注入量、单侧或双侧穿刺、骨水泥是否过中线对称分布、骨水泥泄露、骨水泥接触上下终板、术前骨折椎体数量、术前骨折椎体分布、术前骨折压缩程度、术后服用抗骨质疏松药物、术前骨密度值、术前有无陈旧性椎体骨折、术后Cobb角改变及术后前缘高度恢复率,并进行单因素独立样本t检验及多因素logistic回归分析。结果与结论:①两组间年龄、骨水泥是否过中线对称分布与骨水泥终板分布比较差异有显著性意义(P<0.05),其余指标比较差异无显著性意义(P>0.05)。②多因素logistic回归分析显示,高龄(P=0.006,OR=1.086)、骨水泥接触上下终板(P=0.025,OR=2.516)及骨水泥在椎体中不过中线对称(P=0.012,OR=0.344)是术后椎体再发骨折的独立危险因素。③结果表明,骨质疏松性椎体压缩骨折患者高龄状态、骨水泥同时接触上下终板及未过中线对称是经皮椎体后凸成形术后再发骨折的独立危险因素,骨水泥在椎体内的不同分布通过改变椎体内应力及脊柱力线进而影响术后再发骨折。BACKGROUND:At present,the possible risk factors and pathogenesis of the recurrent vertebral fractures after injection of calcium phosphate cement in percutaneous kyphoplasty are still controversial.The main points are related to the clinical characteristics of patients and surgical related factors.OBJECTIVE:To investigate the risk factors of the recurrent fractures in patients with osteoporotic vertebral compression fracture after injection of calcium phosphate cement in percutaneous kyphoplasty.METHODS:The clinical data of 162 patients(191 vertebrae)with osteoporotic vertebral compression fractures admitted to the Third Affiliated Hospital of Anhui Medical University from February 2016 to February 2018 were retrospectively analyzed.All patients,aged 51-88 years,were treated with kyphoplasty and injection of calcium phosphate cement.All patients were followed up for more than 2 years.There were 34 cases(44 vertebrae)with refracture after operation,and 128 cases(147 vertebrae)without refracture as control group.The age,sex ratio,bone cement injection volume,unilateral or bilateral puncture,symmetrical distribution of bone cement across the midline,leakage of bone cement,contact of bone cement with upper and lower endplates,number of fractured vertebral bodies before operation,distribution of fractured vertebral bodies before operation,compression degree of fracture before operation,taking anti-osteoporosis drugs after operation,bone mineral density before operation and old vertebral fractures before operation,Cobb angle change after operation and recovery rate of anterior edge height after operation were compared between the two groups.Univariate independent sample t-test and multivariate logistic regression analysis were performed.RESULTS AND CONCLUSION:(1)There were significant differences between the two groups in age,symmetrical distribution of bone cement across the midline and distribution of bone cement on endplate(P<0.05),but there were no significant differences in other indexes(P>0.05).(2)Multivariate lo

关 键 词：椎体后凸成形 自固化磷酸钙骨水泥 骨质疏松 椎体压缩骨折 再发椎体骨折 高龄 骨水泥分布 应力 

分 类 号：R459.9[医药卫生—治疗学] R683.2[医药卫生—临床医学]