骨质疏松性椎体压缩骨折老年患者行经皮椎体后凸成形术后再骨折的影响因素分析  

Analysis of factors affecting refracture after percutaneous vertebral kyphoplasty in elderly patients with osteoporotic vertebral compression fractures

作　　者：季兴华 魏金政 段宇晨 张蔚 柳青青 邢泽军 Ji Xinghua;Wei Jinzheng;Duan Yuchen;Zhang Wei;Liu Qingqing;Xing Zejun(Department of Orthopedics,Shanri Bethune Hospital(Tongji Shanzi Hospital of Shanzri Academy of Medical Sciences),Third Hospital of Shanri Medical University,Taiyuan 030032,China;First Clinical Medicine College of Shanri Medical University,Taiyuan 030001,China;Economics College of Hebei Geo University,Shijiazhuang 050030,China)

机构地区：[1]山西白求恩医院(山西医学科学院同济山西医院)、山西医科大学第三医院骨科,太原030032 [2]山西医科大学第一临床医学院,太原030001 [3]河北地质大学经济学院,石家庄050030

出　　处：《中华老年医学杂志》2024年第11期1445-1450,共6页Chinese Journal of Geriatrics

基　　金：山西省卫生健康委员会课题(2020011);河北省研究生创新资助项目(CXZZSS2024115)。

摘　　要：目的探讨骨质疏松性椎体压缩骨折(OVCF)的老年患者经皮椎体后凸成形术(PKP)后再骨折的影响因素。方法回顾性分析2017年1月至2022年12月于山西省白求恩医院骨科行PKP手术治疗的OVCF老年患者的临床资料, 术后至少随访1年, 根据术后是否发生再骨折将所有老年患者分为再骨折组59例和非再骨折组200例。对收集的资料进行单因素分析和多因素Logistic回归分析OVCF老年患者行PKP术后再骨折的影响因素。结果单因素分析结果显示, 再骨折组和非再骨折组老年患者性别、糖尿病史、吸烟史、激素用药史、体质指数(BMI)差异均无统计学意义;再骨折组的年龄较非再骨折组的年龄大(t=9.085、P=0.003)。术前指标的术前血钙、术前血磷、首次骨折部位差异均无统计学意义(均P>0.05), 再骨折组首次骨折至手术时间>14 d比非再骨折组的比率更高(χ2=20.409、P=0.001), 首次骨折椎体数量再骨折组较非再骨折组的数量更多(t=6.189、P=0.017)。再骨折组和非再骨折组骨水泥注入方式、骨水泥注入量、骨水泥分布情况差异均无统计学意义(均P>0.05), 两组术后抗骨质疏松治疗比例(χ2=13.431、P=0.001)、骨密度(χ2=13.431、P=0.001)的差异均有统计学意义。经多因素Logistic回归分析结果显示, 年龄增大(OR=1.061、95%CI:1.021~1.103、P=0.003)、首次骨折至手术时间>14 d(OR=5.026、95%CI:1.968~12.835、P=0.001)、未进行抗骨质疏松治疗(OR=3.493、95%CI:1.239~9.846、P=0.018)以及骨密度降低(OR=10.682、95%CI:2.707~42.151、P=0.001)是术后发生继发椎体压缩性骨折的影响因素。结论 OVCF老年患者行PKP术后再骨折的独立危险因素有年龄增大、首次骨折至手术时间>14 d、未进行抗骨质疏松治疗以及骨密度降低, 在实际临床治疗中, 可根据以上危险因素采取有针对性的措施进行预防及有效治疗, 以改善OVCF老年患者的预后。ObjectiveeTo explore risk factors for refracture after percutaneous kyphoplasty(PKP)in elderly patients with osteoporotic vertebral compression fractures(OVCF)and provide clinical guidance.Methods A retrospective analysis was conducted on clinical data from elderly patients with OVCF who underwent PKP surgery at the Department of Orthopedics,Shanxi Bethune Hospital,between January 2017 and December 2022.All patients were followed up for a minimum of one-year post-surgery.The elderly patients were categorized into a refracture group(59 cases)and a nonrefracture group(2o0 cases)based on post-surgery refracture occurrence.Univariate analysiss was initially conducted on the collected data,followed by multivariate Logistic regression analysis on statistically significant indicators to identify risk factors for refracture in elderly patients with OVCF following PKP.Results The results of the univariate analysis indicated that there was no statistically significant difference in gender,history of diabetes mellitus,history of smoking,history of hormone medication,and body mass index(BMI)between the refracture group and the non-refracture group of elderly patients.However,the refracture group was found to be older than the non-refracture group(t=9.085,P=0.003).Additionally,there were no significant differences in preoperative indicators such as preoperative calcium,preoperative phosphorus,and site of first fracture(all P>0.05).The time from first fracture to surgery being greater than 14 days was more common in the refracture group compared to the non-refracture group(x?=20.409,P=0.001),and the number of vertebrae fractured for the first time was higher in the re-fracture group(t=6.189,P=0.017).Cement injection method,amount of cement injected,and distribution of cement did not show significant differences between the two groups(all P>0.05).However,there were statistically significant variations in the proportion of postoperative anti-osteoporosis treatment(X^(2)=13.431,P=0.001)and bone mineral density(X^(2)=13.431,P=0.00

关 键 词：骨质疏松 骨折 压缩性 再骨折 影响因素 

分 类 号：R687.3[医药卫生—骨科学]