骨质疏松性椎体压缩骨折患者经皮椎体后凸成形术术后再骨折的危险因素分析  

Risk factors for refracture after percutaneous kyphoplasty in patients with osteoporotic vertebral compression fracture

作　　者：谢海峰 吴天翼 王金宁[1] 宋达玮[1] 钮俊杰 邹俊[1] Xie Haifeng;Wu Tianyi;Wang Jinning;Song Dawei;Niu Junjie;Zou Jun(Department of Orthopedic Surgery,First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院骨科,苏州215006

出　　处：《中华创伤杂志》2024年第5期440-445,共6页Chinese Journal of Trauma

基　　金：国家重点研发计划(2022YFC2009700)。

摘　　要：目的探讨骨质疏松性椎体压缩骨折(OVCF)患者经皮椎体后凸成形术(PKP)术后再骨折的危险因素。方法采用回顾性队列研究分析2019年6月至2022年6月苏州大学附属第一医院收治的149例OVCF患者的临床资料,其中男21例,女128例;年龄56~97岁[(73.2±8.7)岁]。初次手术节段:T_(7)1例,T_(8)10例,T_(9)6例,T_(10)6例,T_(11)19例,T_(12)28例,L_(1)38例,L_(2)18例,L_(3)11例,L_(4)7例,L_(5)5例。根据PKP术后是否再骨折分为再骨折组(32例)和非再骨折组(117例)。再骨折节段:T_(8)2例,T_(9)2例,T_(11)4例,T_(12)5例,L_(1)7例,L_(2)4例,L_(3)6例,L_(5)2例。记录两组性别、年龄、基础疾病(高血压、糖尿病)、体重指数(BMI)、术前骨密度(BMD)、吸烟史、饮酒史、随访时间、术前视觉模拟评分(VAS)、术前Oswestry功能障碍指数(ODI);计算两组术前椎旁肌相关参数,包括双侧腰大肌、双侧竖脊肌、双侧多裂肌和椎体横截面积,椎旁肌质量及椎体骨质量(VBQ)评分。采用单因素分析评估上述指标与OVCF患者PKP术后再骨折的相关性。采用多因素Logistic回归分析确定OVCF患者PKP术后再骨折的独立危险因素。结果单因素分析结果显示,BMI、术前BMD、双侧腰大肌横截面积、双侧竖脊肌横截面积、双侧多裂肌横截面积、椎旁肌质量、VBQ评分与OVCF患者PKP术后再骨折有一定相关性(P<0.01);而性别、年龄、高血压、糖尿病、吸烟史、饮酒史、随访时间、术前VAS、术前ODI、椎体横截面积与OVCF患者PKP术后再骨折不相关(P>0.05)。多因素Logistic回归分析结果表明,术前BMD≤-3.4 SD(OR=0.27,95%CI 0.09,0.80,P<0.05)、椎旁肌质量≤281.2%(OR=0.98,95%CI 0.97,0.99,P<0.01)、VBQ评分≥4.8分(OR=4.41,95%CI 1.18,16.44,P<0.05)与OVCF患者PKP术后再骨折显著相关。结论术前BMD≤-3.4 SD、椎旁肌质量≤281.2%、VBQ评分≥4.8分是OVCF患者PKP术后再骨折的独立危险因素。Objective To investigate the risk factors for refracture after percutaneous kyphoplasty(PKP)in patients with osteoporotic vertebral compression fracture(OVCF).Methods A retrospective cohort study was conducted on the clinical data of 149 OVCF patients who were admitted to the First Affiliated Hospital of Soochow University from June 2019 to June 2022,including 21 males and 128 females,aged 56‑97 years[(73.2±8.7)years].Initial surgical segments included T_(7) in 1 patient,T_(8) in 1_(0),T_(9) in 6,T_(10) in 6,T_(11 )in 19,T_(12) in 28,L_(1) in 38,L_(2) in 18,L_(3) in 11,L_(4) in 7 and L_(5) in 5.Patients were divided into refracture group(n=32)and non‑refracture group(n=117)according to whether they had postoperative refracture after PKP.Refractured surgical segments included T_(8) in 2 patients,T_(9) in 2,T_(11) in 4,T_(12) in 5,L_(1) in 7,L_(2) in 4,L_(3) in 6,and L_(5) in 2.The age,gender,underlying diseases(hypertension,diabetes),body mass index(BMI),preoperative bone mineral density(BMD),smoking history,drinking history,follow‑up time,preoperative visual analogue scale(VAS),and preoperative Oswestry dysfunction index(ODI)of the two groups were recorded.Preoperative paravertebral muscle‑related parameters of the two groups were calculated including cross‑sectional area of bilateral psoas,bilateral erector spinae,bilateral multifidus,and vertebral bodies,paravertebral muscle mass,and vertebral bone quality(VBQ)score.Univariate analysis was performed to evaluate the correlation between the fore‑mentioned indicators and postoperative refracture after PKP in OVCF patients.Multivariate logistic regression analysis was employed to identify the independent risk factors for postoperative refracture after PKP in OVCF patients.Results Univariate analysis revealed that there was certain correlation of BMI,preoperative BMD,cross‑sectional area of bilateral psoas,bilateral erector spinae,bilateral multifidus,paravertebral muscle mass and VBQ score with postoperative refracture after PKP in OVCF patients(P<0.

关 键 词：脊柱骨折 骨质疏松 椎体成形术 椎旁肌质量 

分 类 号：R687.3[医药卫生—骨科学]