骨质疏松性椎体骨折术后血钙、骨代谢状态变化及再骨折风险分析  

Analysis on the risk of refracture after osteoporotic vertebral fracture with changes in blood calcium and bone metabolism

作　　者：潘洪 陈宏 林宗阳 刘志荣 丁舒晨 Pan Hong;Chen Hong;Lin Zongyang;Liu Zhirong;Ding Shuchen(Department of Orthopaedics,Ninth Third Hospital,Joint Logistics Support Force of the Chinese People’s Liberation Army,Hangzhou 310016,China)

机构地区：[1]中国人民解放军联勤保障部队第九〇三医院骨四科,杭州310016

出　　处：《中华内分泌外科杂志》2022年第1期108-112,共5页Chinese Journal of Endocrine Surgery

基　　金：杭州市医药卫生科技项目 (B20200446)。

摘　　要：目的探讨骨质疏松性椎体骨折术后血钙骨代谢状态的变化及再骨折的风险分析。方法选择2018年2月至2020年2月中国人民解放军联勤保障部队第九〇三医院骨四科治疗的骨质疏松性椎体骨折患者260例进行研究,所有患者均给予脊柱后凸成形术治疗。观察临床疗效、血钙、PINP、β-CTX水平变化情况,随访术后再发骨折情况,收集患者临床资料,分析骨质疏松性椎体骨折患者术后再发骨折的危险因素,采用受试者工作特征曲线分析血钙、PINP、β-CTX在骨质疏松性椎体骨折术后再发骨折中的预测价值。结果治疗后,临床总有效率为95.77%(249/260);治疗后,患者血钙、PINP、β-CTX均随着时间的推移而降低,较治疗前差异显著(P<0.05)。所有患者均随访6个月,术后再发骨折81例(31.15%),未再发骨折179例(68.85%)。单因素分析两组年龄、性别、BMI、外伤史、基础疾病、手术椎体部位、手术椎体节段、脊柱矢状面后凸矫正角度、骨水泥注入量差异无统计学意义(P>0.05);长期糖皮质激素使用史、术前骨折椎体数、手术椎体数、血钙、PINP、β-CTX、骨折压缩率、椎体高度恢复率、强化椎体数、骨水泥渗漏与骨质疏松性椎体骨折患者术后再发骨折相关(P<0.05)。多因素非条件Logistic分析显示,长期糖皮质激素使用史、术前骨折椎体数、手术椎体数、骨折压缩率、椎体高度恢复率、强化椎体数、骨水泥渗漏、血钙、PINP、β-CTX均是骨质疏松性椎体骨折患者术后再发骨折的独立危险因素(P<0.05)。ROC曲线结果显示,血清血钙预测骨质疏松性椎体骨折患者术后再发骨折AUC为0.820,95%CI为0.770~0.871,截断值为2.12 mmol/L;PINP预测骨质疏松性椎体骨折患者术后再发骨折AUC为0.915,95%CI为0.873~0.957,截断值为45.51 ng/ml;β-CTX预测骨质疏松性椎体骨折患者术后再发骨折AUC为0.973,95%CI为0.957~0.988,截断值为463.29ng/ml。结论在骨质疏�Objective To study the risk of refracture after osteoporotic vertebral fracture with changes in blood calcium and bone metabolism.Methods 260 patients with osteoporotic vertebral fracture treated in our hospital from Feb.2018 to Feb.2020 were selected for study.All patients were treated with kyphoplasty.The clinical curative effect,blood calcium,PINP,andβ-CTX level changes were observed,postoperative recurrence was followed up.Clinical data of fracture patients were collected,risk factors of osteoporotic vertebral fractures in patients with postoperative recurrence of fracture were analyzed,receiver-operating characteristic curve was drawn to analyze the predictive value of blood calcium,PINP,andβ-CTX in postoperative recurrence of osteoporotic vertebral fracture.Results The total clinical response rate was 95.77%(249/260)after treatment.After treatment,serum calcium,PINP,andβ-CTX decreased with time,and the difference was significant(P<0.05).All patients were followed up for 6 months.There were 81 cases(31.15%)suffering postoperative fracture and 179 cases(68.85%)without fracture.According to univariate analysis,there were no statistically significant differences in age,sex,BMI,history of trauma,underlying disease,site of surgical vertebral body,segment of surgical vertebral body,correction angle of sagittal kyphosis,or amount of bone cement injection between the two groups(P>0.05).Long-term history of glucocorticoid use,preoperative fractured vertebra number,surgical vertebra number,blood calcium,PINP,β-CTX,fracture compression rate,vertebra height recovery rate,reinforced vertebra number,and bone cement leakage were correlated with postoperative recurrence of fracture in patients with osteoporotic vertebral fracture(P<0.05).Multivariate Logistic analysis showed that long-term history of glucocorticoid use,preoperative number of fractured vertebrae,surgical vertebra number,fracture compression rate,vertebral height recovery rate,enhanced vertebral body number,bone cement leakage,blood calcium,PINP,andβ-CTX

关 键 词：脊柱后凸成形术 骨质疏松 骨折 I型胶原氨基端前肽 1型胶原交联羧基端肽β特殊序列 

分 类 号：R658.3[医药卫生—外科学] R738.1[医药卫生—临床医学]