胸腰椎骨折椎弓根螺钉内固定术后椎体高度再丢失的相关影响因素分析  

Analysis on influencing factors of vertebral body height reloss after pedicle screw fixation of thoracolumbar fracture

作　　者：申科律 计李超 成茂华[1] 周晓中[1] 贲兴磊 魏启启 陈海南[1] 陆政峰[1] Shen Kelyu;Ji Lichao;Cheng Maohua;Zhou Xiaozhong;Ben Xinglei;Wei Qiqi;Chen Hainan;Lu Zhengfeng(Department of Orthopedics,Second Affiliated Hospital of Soochow University,Suzhou 215004,China)

机构地区：[1]苏州大学附属第二医院骨科,215004

出　　处：《中华创伤杂志》2021年第11期990-996,共7页Chinese Journal of Trauma

基　　金：国家自然科学基金(82074173)。

摘　　要：目的探讨胸腰椎骨折椎弓根螺钉内固定术后椎体高度再丢失的相关影响因素并筛查最佳预测点。方法采用回顾性病例对照研究分析2010年1月至2017年12月苏州大学附属第二医院收治的215例胸腰椎骨折患者临床资料,其中男155例,女60例;年龄21~80岁[(48.6±10.4)岁]。按照Denis骨折分类法:压缩性骨折73例(A型15例,B型51例,C型7例),爆裂性骨折135例(A型28例,B型87例,C型20例),屈曲牵张型骨折7例(A型4例,B型2例,C型1例)。均行椎弓根螺钉内固定手术。随访时间为12~48个月[(23.8±8.2)个月],86例发生椎体高度丢失(丢失组),129例未发生椎体高度丢失(未丢失组)。比较两组性别、年龄、亚洲人骨质疏松自我筛查工具(OSTA)指数、体重指数(BMI)、骨折类型、骨折椎体数、术前矢状面Cobb角、术前椎体压缩程度、伤椎置钉数、椎体复位程度等;采用单因素分析上述因素与椎体高度再丢失的相关性;采用多因素Logistic回归分析与椎体高度再丢失的独立危险因素;分别绘制受试者工作特征(ROC)曲线,分析曲线下面积(AUC),并根据ROC曲线筛查术后椎体高度再丢失的最佳预测点。结果两组性别、年龄、BMI、骨折类型、骨折椎体数、术前矢状面Cobb角和伤椎置钉数差异无统计学意义(P>0.05),OSTA指数、术前椎体压缩程度及伤椎椎体复位程度的差异有统计学意义(P<0.05)。单因素分析结果表明,OSTA指数、术前椎体压缩程度及伤椎椎体复位程度与术后椎体高度再丢失有一定的相关性(P<0.05)。多因素Logistic回归分析结果表明,OSTA指数(OR=1.109,95%CI 0.527~0.685,P<0.05)和术前椎体压缩程度(OR=0.038,95%CI 0.539~0.689,P<0.05)与术后椎体高度再丢失显著相关。预测术后椎体高度再丢失的AUC分别为0.606和0.614,分析得出OSTA指数1.9及术前椎体压缩程度31.3%分别为术后椎体高度再丢失的最佳预测点。结论OSTA指数、术前椎体压缩程度是胸腰椎骨Objective To investigate the related factors of vertebral body height reloss after pedicle screw fixation of thoracolumbar fracture and to determe the optimum prediction point.Methods A retrospective case control study was made on 215 patients with thoracolumbar fracture admitted to Second Affiliated Hospital of Soochow University from January 2010 to December 2017.There were 155 males and 60 females,aged 21-80 years[(48.6±10.4)years].According to Denis fracture classification,there were 73 patients with compression fractures(type A in 15 patients,type B in 51,type C in 7),135 burst fractures(type A in 28 patients,type B in 87,type C in 20)and flexion distraction fractures(type A in 4,type B in 2,type C in 1).All patients were treated by pedicle screw fixation.Follow-up lasted for 12-48 months[(23.8±8.2)months].Vertebral body height loss occurred in 86 patients(loss group),but did not in 129 patients(non-loss group).The two groups were compared concerning sex,age,osteoporosis self-assessment tool for Asians(OSTA),body mass index(BMI),fracture types,number of fractured vertebrae,preoperative sagittal Cobb angle,preoperative degree of vertebral compression,number of screws placed in injured vertebrae,extent of vertebral reset and other related factors.Univariate analysis was used to identify the correlation of those factors with vertebral body height reloss.Multivariate Logistic regression analysis was performed to identify the independent factors for the height reloss with the receiver operating characteristic curve(ROC)and area under the curve(AUC)calculated to evaluate the optimum point in prediction of vertebral height reloss.Results The two groups showed no significant differences in sex,age,BMI,fracture types,number of injured vertebrae,preoperative sagittal Cobb angle and number of screws placed in injured vertebrae(P>0.05),but the differences were statistically significant in OSTA,preoperative degree of vertebral compression and extent of vertebral reset(P<0.05).According to the univariate analysis,OSTA,p

关 键 词：脊柱骨折 骨折固定术 内 构造塌陷 椎弓根螺钉 

分 类 号：R687.3[医药卫生—骨科学]