椎旁肌CT值与骨质疏松性腰椎骨折患者经皮椎体成形术后再骨折的关系  

The Relationship between Paravertebral Muscle CT Values and Refractures after Percutaneous Vertebroplasty in Patients with Osteoporotic Lumbar Fractures

作　　者：刘祖耀[1] 李强[2] 李富[3] 张洪剑[2] 杨等 吕朝辉 LIU Zuyao;LI Qiang;LI Fu;ZHANG Hongjian;YANG Deng;LǓZhaohui(a.Health Management Center of Model Workers,Beijing Rehabilitation Hospital Affiliated to Capital Medical University,Beijing,100144,China;Department of Orthopedics,Beijing Rehabilitation Hospital Affiliated to Capital Medical University,Beijing,100144,China;Musculoskeletal Rehabilitation Center,Beijing Rehabilitation Hospital Affiliated to Capital Medical University,Beijing,100144,China;Urology and Metabolism Rehabilitation Center,Beijing Rehabilitation Hospital Affiliated to Capital Medical University,Beijing,100144,China;Department of Orthopedics,Pinggu District Hospital of Traditional Chinese Medicine,Beijing 101200,China)

机构地区：[1]北京首都医科大学附属北京康复医院劳模健康管理中心,北京100144 [2]北京首都医科大学附属北京康复医院骨科,北京100144 [3]北京首都医科大学附属北京康复医院肌骨康复中心,北京100144 [4]北京首都医科大学附属北京康复医院泌尿与代谢康复中心,北京100144 [5]北京市平谷区中医医院骨科,北京100144

出　　处：《转化医学杂志》2025年第3期50-55,共6页Translational Medicine Journal

基　　金：2022年首都卫生发展科研专项重点攻关项目(2022-1-7032)。

摘　　要：目的探讨椎旁肌CT值与骨质疏松性腰椎骨折患者经皮椎体成形术(PVP)后再骨折的关系。方法选取2022年4月至2023年4月北京康复医院骨科收治的行PVP治疗的120例骨质疏松性腰椎骨折患者作为研究对象。术后影像学随访1年,根据是否发生骨质疏松性椎体再骨折将患者分为再骨折组(26例)和未再骨折组(94例)。测量所有研究者椎旁肌CT值(椎后肌群平均CT值、腰大肌平均CT值)。采用Spearman相关分析探讨椎旁肌CT值与PVP后再骨折的关系,采用受试者工作特性(ROC)曲线分析椎旁肌CT值对PVP后再骨折的预测价值,采用多因素Logistic回归分析PVP后再骨折的影响因素。结果再骨折组患者椎后肌群平均CT值、腰大肌平均CT值明显低于未再骨折组,差异有统计学意义(P<0.05);骨质疏松性腰椎骨折患者椎后肌群平均CT值、腰大肌平均CT值与PVP后再骨折呈负相关(P<0.05);椎后肌群平均CT值、腰大肌平均CT值预测PVP后再骨折的曲线下面积(AUC)分别为0.731(95%CI:0.681~0.776)、0.849(95%CI:0.799~0.894),两者联合预测的AUC为0.907(95%CI:0.857~0.952)。再骨折组年龄、身体质量指数、骨水泥注入量、骨水泥渗漏比例明显高于未再骨折组,骨密度T值低于未再骨折组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄(OR=1.893,95%CI:1.150~3.114)、骨水泥渗漏(OR=2.067,95%CI:1.249~3.420)、骨密度T值(OR=2.649,95%CI:1.626~4.315)、骨水泥注入量(OR=2.368,95%CI:1.491~3.761)、椎后肌群平均CT值(OR=2.821,95%CI:1.658~4.798)、腰大肌平均CT值(OR=3.267,95%CI:1.944~5.493)是PVP后再骨折的影响因素(P<0.05)。结论椎旁肌CT值与患者PVP术后再骨折呈负相关,较低的椎后肌群平均CT值和腰大肌平均CT值是PVP术后再骨折的重要影响因素。Objective To investigate the relationship between paravertebral muscle CT values and re-fracture after percutaneous vertebroplasty(PVP)in patients with osteoporotic lumbar fracture.Methods A total of 120 cases with osteoporotic lumbar fracture who underwent PVP from April 2022 to April 2023 were selected.All patients received 1-year radiographic follow-up.According to the occurrence of osteoporotic vertebral refracture,120 patients were divided into refracture group(n=26)and non-refracture group(n=94).The CT values of paravertebral muscles(mean CT values of posterior vertebral muscles and mean CT values of psoas major muscles)were measured in all subjects.Spearman correlation analysis was used to investigate the relationship between paravertebral muscle CT value and re-fracture after PVP.Receiver operating characteristic(ROC)curve analysis was used to analyze the predictive value of paravertebral muscle CT value on re-fracture after PVP,and multi-factor logistic regression was used to analyze the influencing factors of re-fracture after PVP.Results The average CT values of posterior vertebral muscle group and psoas major muscle in refracture group were lower than those in non-refracture group(P<0.05).The mean CT values of posterior vertebral muscle group and psoas major muscle in patients with osteoporotic lumbar fracture were negatively correlated with refractures after PVP(P<0.05).The AUC of posterior vertebral muscle and psoas major muscle were 0.731(95%CI:0.681-0.776)and 0.849(95%CI:0.799-0.894),respectively,and the AUC of combined prediction was 0.907(95%CI:0.857-0.952).The age,body mass index,bone cement injection amount and the proportion of bone cement leakage in the re-fracture group were higher than those in the non-re-fracture group,and the bone mineral density T value was lower than that in the non-re-fracture group(P<0.05).Age(OR=1.893,95%CI:1.150-3.114),bone cement leakage(OR=2.067,95%CI:1.249-3.420),bone mineral density(OR=2.649,95%CI:1.626-4.315),bone cement injection volume(OR=2.368,95%CI:1.491-3

关 键 词：骨质疏松性腰椎骨折 经皮椎体成形术 再骨折 相关性 

分 类 号：R683[医药卫生—骨科学]