经皮椎体强化术后邻近椎体再骨折的危险因素分析及简易评分量表构建  

Risk factor analysis and construction of a simple score scale for adjacent vertebral fractures after percutaneous vertebral augmentation

作　　者：杨进 张树宝 葛晓勇 任昶旭 王善金[1] Yang Jin;Zhang Shubao;Ge Xiaoyong;Ren Changxu;Wang Shanjin(Department of Spinal Surgery,East Hospital,Tongji University,Shanghai 200120,China)

机构地区：[1]同济大学附属东方医院脊柱外科,上海200120

出　　处：《脊柱外科杂志》2024年第6期368-373,共6页Journal of Spinal Surgery

基　　金：浦东新区卫生健康委员会学科带头人培养计划项目(PWRd2020-11);浦东新区卫生健康委员会卫生科技联合攻关项目(PW2023D-12);浦东新区卫生系统学科建设特色专病项目(PWZzb2022-22)。

摘　　要：目的分析骨质疏松性椎体压缩性骨折(OVCF)患者经皮椎体强化术(PVA)术后邻近椎体再骨折(AVF)的危险因素,并构建简易评分量表。方法回顾性分析2018年1月—2022年1月接受PVA治疗的313例OVCF患者临床资料,根据术后是否发生AVF分为AVF组(n=86)和对照组(n=227),采用单因素分析和多因素logistic回归分析筛选AVF的独立危险因素,建立AVF风险预测模型,并构建简易评分量表,采用受试者工作特征(ROC)曲线评估该量表的灵敏度和特异度。结果单因素分析结果显示,2组患者在年龄、骨折史、是否抗骨质疏松药物治疗、血清维生素D水平、椎体HU值、椎旁肌HU值、骨水泥有无椎间隙渗漏和骨水泥分布形态方面差异具有统计学意义(P<0.05)。Logistic回归分析结果显示,年龄>77.5岁、未行抗骨质疏松药物治疗、存在骨水泥椎间隙渗漏和椎体HU值≤65.0与OVCF患者PVA术后发生AFV具有相关性,并基于logistic回归分析建立AVF风险预测的简易评分量表,该量表的ROC曲线下面积(AUC)为0.758,分数≥3分时灵敏度和特异度分别为94.2%和50.7%。结论年龄>77.5岁、未行抗骨质疏松药物治疗、存在骨水泥椎间隙渗漏和椎体HU值≤65.0是OVCF患者PVA术后发生AVF的独立危险因素,据此构建的简易评分量表具有良好的预测效能,可为评估PVA术后AVF的发生风险提供参考。Objective To analyze the risk factors of adjacent vertebral fractures(AVF)in osteoporotic vertebral compression fracture(OVCF)patients after percutaneous vertebral augmentation(PVA),and to construct a simple score scale.Methods The clinical data of 313 OVCF patients treated with PVA from January 2018 to January 2022 were retrospectively analyzed,and the patients were divided into AVF group(n=86)and control group(n=227)according to whether AVF occurred after surgery.Independent risk factors associated with AVF were obtained through univariate analysis and multivariate logistic regression analysis,and a prediction model of AVF risk was established.A simple score scale was constructed,and the sensitivity and specificity of the scale were evaluated by receiver operating characteristics(ROC)curve.Results Univariate analysis showed that there were statistically significant differences between the 2 groups in age,fracture history,whether treated with anti-osteoporosis medication,serum vitamin D level,vertebral HU value,paraverteinal muscle HU value,whether with intervertebral leakage of bone cement and distribution morphology of bone cement(P<0.05).Logistic regression analysis showed that age>77.5,without anti-osteoporosis medication treatment,presence of bone cement intervertebral leakage,and vertebral HU value≤65.0 were correlated with AFV after PVA.A simple score scale for AVF risk prediction was established based on logistic regression analysis.The area under the ROC curve(AUC)of the scale was 0.758,and the sensitivity and specificity were 94.2%and 50.7%,respectively,when the score was≥3.Conclusions Age>77.5,without anti-osteoporosis medication treatment,presence of bone cement intervertebral leakage,and vertebral HU value≤65.0 are independent risk factors for AVF after PVA.The simple score scale constructed based on this has good predictive efficacy,and can provide a reference for evaluating the risk of AVF after PVA.

关 键 词：胸椎 腰椎 骨折 压缩性 骨质疏松 椎体成形术 椎体后凸成形术 

分 类 号：R683.2[医药卫生—骨科学]