术前椎体压缩程度联合骨密度对胸腰椎骨折椎弓根螺钉内固定术后椎体高度再丢失的预测  

Prediction of preoperative vertebral compression degree combined with bone mineral density in re-loss of vertebral body height after pedicle screw internal fixation for thoracolumbar fractures

作　　者：张林 陈晓钢 季沐梵 丁静 刘青柏 ZHANG Lin;CHEN Xiao-gang;JI Mu-fan;DING Jing;LIU Qing-bai(Department of Orthopedics,Huai′an First Hospital,Nanjing Medical University,Jiangsu Province,Huaian 223000,China;Medical College of Nantong University,Jiangsu Province,Nantong 226000,China;Department of Orthopedics,Nanjing First Hospital,Nanjing Medical University,Jinagsu Province,Nanjing 210000,China)

机构地区：[1]南京医科大学附属淮安第一医院骨科,江苏淮安223000 [2]南通大学医学院,江苏南通226000 [3]南京医科大学附属南京第一医院骨科,江苏南京210000

出　　处：《河北医科大学学报》2023年第3期274-278,共5页Journal of Hebei Medical University

基　　金：江苏省自然科学基金(BK20181494);淮安市科技计划项目(HAB201933)。

摘　　要：目的探讨术前椎体压缩程度、骨密度对胸腰椎骨折椎弓根螺钉内固定术后椎体高度再丢失的预测价值。方法选取86例胸腰椎骨折患者为研究对象。随访1年,统计胸腰椎骨折患者术后椎体高度再丢失发生情况,并依据患者是否发生椎体高度再丢失将胸腰椎骨折患者分为丢失组(31例)和未丢失组(55例)。比较丢失组和未丢失组患者的临床资料。比较丢失组和未丢失组术前椎体压缩程度和骨密度。Logistic回归分析影响椎体高度再丢失发生的危险因素。制作受试者工作特征曲线(receiver operating characteristic curve,ROC),以曲线下面积(area under curve,AUC)分析术前椎体压缩程度、骨密度及两者联合对椎弓根螺钉内固定术后椎体高度再丢失发生的预测效能。结果截止随访结束,椎体高度再丢失发生率为36.05%。丢失组术中多次进钉、术后早期负重占比、术前椎体压缩程度高于未丢失组(P<0.05),术前骨密度则低于未丢失组(P<0.05)。Logistic回归分析结果显示,术中多次进钉(OR=2.869,95%CI:1.045~4.183)、术后早期负重(OR=2.956,95%CI:1.632~5.279)、术前椎体压缩程度(OR=3.615,95%CI:2.873~9.418)及术前骨密度(OR=3.284,95%CI:2.084~7.436)均为影响胸腰椎骨折椎弓根螺钉内固定术后椎体高度再丢失发生的危险因素(P<0.05)。ROC曲线分析结果显示,术前椎体压缩程度、骨密度及两者联合对椎弓根螺钉内固定术后椎体高度再丢失预测的敏感度分别为70.97%(95%CI:51.76%~85.11%)、74.19%(95%CI:55.07%~87.46%)、70.97%(95%CI:51.76%~85.11%),特异度分别为76.36%(95%CI:62.67%~86.35%)、72.73%(95%CI:58.81%~83.46%)、93.36%(95%CI:86.39%~99.37%),AUC分别为0.706(95%CI:0.598~0.801)、0.757(95%CI:0.653~0.841)、0.883(95%CI:0.793~0.945)。结论术前椎体压缩程度、骨密度两者联合对胸腰椎骨折术后椎体高度再丢失的预测价值较高。Objective To investigate the predictive value of preoperative vertebral compression degree combined with bone mineral density in the re-loss of vertebral body height after pedicle screw internal fixation for thoracolumbar fractures.Methods To investigate the predictive value of preoperative vertebral compression degree combined with bone mineral density in the re-loss of vertebral body height after pedicle screw internal fixation for thoracolumbar fractures.Results By the end of follow-up,the incidence of vertebral body height re-loss was 36.05%.The loss group had higher intraoperative screw insertion,early postoperative weight-bearing ratio,and preoperative vertebral body compression than the non-loss group(P<0.05),and preoperative bone mineral density was lower than that of the non-loss group(P<0.05).Logistic regression analysis showed that multiple intraoperative screw insertions(OR=2.869,95%CI:1.045-4.183),early postoperative weight-bearing(OR=2.956,95%CI:1.632-5.279),preoperative vertebral compression degree(OR=3.615,95%CI:2.873-9.418)and preoperative bone mineral density(OR=3.284,95%CI:2.084-7.436)were risk factors affecting the re-loss of vertebral body height after pedicle screw internal fixation for thoracolumbar fractures(P<0.05).The results of ROC curve analysis showed that the preoperative vertebral compression degree,bone mineral density,and their combination for predicting the re-loss of vertebral body height after pedicle screw internal fixation had the sensitivity of 70.97%(95%CI:51.76%-85.11%),74.19%(95%CI:55.07%-87.46%),and 70.97%(95%CI:51.76%-85.11%),respectively,the specificity of 76.36%(95%CI:62.67%-86.35%),72.73%(95%CI:58.81%-83.46%),and 93.36%(95%CI:86.39%-99.37%),respectively,and AUC of 0.706(95%CI:0.598-0.801),0.757(95%CI:0.653-0.841),and 0.883(95%CI:0.793-0.945),respectively.Conclusion The combination of preoperative vertebral compression degree and bone mineral density has a higher predictive value for re-loss of vertebral body height after thoracolumbar fractures.

关 键 词：脊柱骨折 骨折固定术 内 骨密度 

分 类 号：R683.2[医药卫生—骨科学]