不同骨密度水平患者PKP术后椎体高度丢失的动态变化规律及影响因素分析  

Dynamic Changes and Influencing Factors of Vertebral Height Loss After PKP Surgery in Patients with Different Bone Density Levels

作　　者：马浩浩 刘润泽 宋月朋 吴肖南 施新革[2] MA Haohao;LIU Runze;SONG Yuepeng;WU Xiaonan;SHI Xinge(Department of Orthopedics,North Ward 1,Henan Provincial People's Hospital,Zhengzhou Henan 450003,China;Department of Spine and Spinal Cord Surgery,Henan Provincial People's Hospital,Zhengzhou Henan 450003,China;Department of Orthopedics,Ward 5,Zhoukou Central Hospital,Zhoukou Henan 466000,China)

机构地区：[1]河南省人民医院骨科北一病区,河南郑州450003 [2]河南省人民医院脊柱脊髓外科,河南郑州450003 [3]周口市中心医院骨科五病区,河南周口466000

出　　处：《临床研究》2025年第3期32-35,共4页Clinical Research

基　　金：河南省二0二三年科技发展计划项目编号(232102311186)。

摘　　要：目的探讨不同骨密度水平患者经皮椎体后凸成形术(PKP)术后椎体高度丢失的动态变化规律及其影响因素。方法前瞻性纳入2022年1月至2023年6月在河南省人民医院行PKP手术的115例骨质疏松性椎体压缩性骨折患者。根据骨密度T值分为骨量正常组(32例)、骨量减少组(45例)和骨质疏松组(38例)。记录患者术前一般资料,测量术前、术后即刻、术后3个月、6个月、12个月椎体高度,计算高度丢失率。分析不同骨密度水平患者椎体高度丢失的动态变化规律,建立预测模型并评估其效能。结果骨质疏松组患者术后12个月椎体高度丢失率[(14.29±2.85)%]显著高于骨量减少组[(10.58±2.24)%]和骨量正常组[(6.01±1.42)%],差异均有统计学意义(P<0.05)。多因素分析显示,T值(OR=3.650,95%CI 2.180~6.120)、骨水泥注入量(OR=2.120,95%CI 1.280~3.520)是椎体高度显著丢失的相关因素,差异均有统计学意义(P<0.05)。预测模型的受试者工作特征(ROC)曲线下面积为0.836(95%CI0.765~0.907),敏感性为78.45%,特异性为82.63%。结论骨密度水平是影响PKP术后椎体高度维持的关键因素,建立预测模型可有效识别高风险患者,为临床治疗方案的制定提供参考依据。Objective To investigate the dynamic changes in vertebral height loss and its influencing factors after percutaneous kyphoplasty(PKP)in patients with different levels of bone density.Methods A total of 115 patients with osteoporotic vertebral compression fractures who underwent PKP at Henan Provincial People's Hospital from January 2022 to June 2023 were prospectively enrolled.According to the T-score of bone density,patients were divided into normal bone mass group(32 cases),mild bone loss group(45 cases),and osteoporosis group(38 cases).General information was recorded preoperatively,and vertebral height was measured preoperatively,immediately postoperatively,and at 3,6,and 12 months postoperatively to calculate the height loss rate.The dynamic changes in vertebral height loss were analyzed for different bone density levels,and a predictive model was established and evaluated for its effectiveness.Results The height loss rate of the osteoporosis group at 12 months postoperatively[(14.29±2.85)%]was significantly higher than that of the mild bone loss group[(10.58±2.24)%]and the normal bone mass group[(6.01±1.42)%],with statistically significant differences(P<0.05).Multivariate analysis revealed that T-score(OR=3.650,95%CI 2.180~6.120)and the volume of injected bone cement(OR=2.120,95%CI 1.280~3.520)were significant factors related to vertebral height loss,with statistically significant differences(P<0.05).The area under the receiver operating characteristic(ROC)curve for the predictive model was 0.836(95%CI 0.765~0.907),with a sensitivity of 78.45%and specificity of 82.63%.Conclusion Bone density level is a key factor affecting the maintenance of vertebral height after PKP,and the established predictive model can effectively identify high-risk patients,providing a reference for clinical treatment planning.

关 键 词：骨质疏松 经皮椎体成形术 椎体高度 骨密度 预测模型 

分 类 号：R683[医药卫生—骨科学]