骨质疏松性椎体压缩骨折术后临近椎体再发骨折的危险因素分析  

Analysis of risk factors of adjacent vertebral compression fracture after osteoporotic vertebral compression fracture operation

作　　者：郝少飞[1] 曹珺[1] 勾瑞恩[1] 马玉斐[1] 崔京福 HAO Shofei;CAO Jun;GOU Ruien;MA Yufei;CUI Jingfu(Department of Spine Surgery,the First People's Hospital of Zhengzhou,Zhengzhou 450004,CHN)

机构地区：[1]郑州市第一人民医院脊柱外科,郑州450004

出　　处：《河南大学学报（医学版）》2024年第5期349-353,371,共6页Journal of Henan University:Medical Science

基　　金：河南省科技攻关计划(242102310182)。

摘　　要：目的:分析骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture OVCF)经皮椎体成形术(percutaneous vertebroplasty,PVP)或经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗后临近椎体再发骨折(adjacentvertebral compression fracture,AVCF)的相关危险因素。方法:回顾性分析2018年4月至2020年2月郑州市第一人民医院脊柱外科行PVP或PKP手术治疗的148例OVCF患者的临床资料,根据术后有无临近椎体再骨折分成AVCF组(27例)和非AVCF组(121例)。记录患者的年龄、性别、初始骨折椎体数量、初始骨折部位(T10-L2、非T10-L2)、体重指数(BMI)、手术方式(PVP、PKP)、术前腰1椎体CT值、术后伤椎高度恢复率。采用Logistic回归分析确定潜在危险因素。结果:所有患者随访6~18mon,平均10 mon。148例中共发现AVCF 27例(18.2%)。两组患者在性别、年龄、初次骨折椎体数、初次骨折部位、手术方式及BMI方面差异均无统计学意义(P>0.05)。AVCF组腰1椎体CT值明显低于非AVCF组(P<0.05),而AVCF组伤椎高度恢复率明显高于非AVCF组(P<0.05)。单因素分析结果显示:腰1椎体CT值与伤椎高度恢复率与OVCF术后AVCF明显相关(P<0.05);多因素分析结果显示:腰1椎体CT值≤80 HU及伤椎高度恢复率是导致OVCF术后AVCF的独立危险因素。结论:腰1椎体CT值伤椎高度恢复率是OVCF患者PVP或PKP术后AVCF的危险因素。Objective:To analyze the related risk factors for adjacent vertebral compression fracture(AVCF)of osteoporotic vertebral compression fracture(OVCF)treated with percutaneous vertebroplasty(PVP)or percutaneous kyphoplasty(PKP).Methods:Retrospectively analyzed the clinical data of 148 patients with OVCF treated with PVP or PKP in the spinal surgery department of Zhengzhou first people's Hospital from April 2018 to February 2020.The patients were divided into AVCF group(27 cases)and non AVCF group(121 cases)according to whether AVCF occurred after operation.The age,gender,initial fracture number,initial fracture site(T10-L2,non-T10-L2),body mass index(BMI),operation method(PVP,PKP),CT value of lumbar 1 vertebral body preoperative,postoperative recovery rate of injured vertebral body height were recorded.Logistic regression analysis was used to determine the potential risk factors.Results:All patients were followed up for 6~18 months,with an average of 10 months.AVCF was observed in 27 patients(18.2%).There was no significant difference between the two groups in terms of gender,age,initial fracture number,initial fracturesite,operation method and BMI(P>0.05).The CT value of L1 vertebral body in AVCF group was significantly lower than that in non AVCF group(P<0.05).The recovery rate of injured vertebral body height in AVCF group was significantly higher than non AVCF group(P<0.05).Univariate analysis showed that the CT value of L1 vertebral body and the recovery rate of injured vertebral body height were significantly correlated with AVCF after OVCF(P<0.05);Multivariate analysis showed that the CT value≤80 HU of L1 vertebral body and the recovery rate of injured vertebral body height were independent risk factors for AVCF after OVCF.Conclusion:CT value of L1 vertebral body and recovery rate of injured vertebral height are risk factors for AVCF after PVP or PKP in OVCF patients.

关 键 词：骨质疏松 椎体压缩骨折 临近椎体再发骨折 相关危险因素 

分 类 号：R687.3[医药卫生—骨科学]