骨密度对骨质疏松性椎体压缩性骨折PKP术后骨折再发风险的评估价值

摘要

Objective To explore the risk factors for re-fracture after percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compression fractures (OVCF),and to evaluate the value of bone mineral density (BMD) as a prognostic indicator for re-fracture.Methods A prospective cohort study including 208 patients,who had osteoporotic vertebral compression fractures and had PKP performed in our hospital.BMD was measured and other general clinical data were also collected and analyzed.All patients were followed up for more than 2 years.The occurrence of re-fracture or death was defined as the end-point event.Kaplan-Meier analysis and multivariate Cox regression model were used for the analysis of risk factors.Receiver operating characteristic curve (ROC curve) was used to evaluate the predictive value of BMD.Results Among all the 208 patients,37 (17.8％) were re-fractured in 2 years.Cox regression analysis showed that BMD,gender,and initial double segment fractures were independent and important predictors for re-fracture.Using BMD as a forecast standard,the ROC area under the curve (AUC) was 0.787,and diagnose critical point was-3.0SD.The sensitivity and specificity were 83.2％ and 66.8％,respectively.Kaplan-Meier analysis revealed that patients with BMD-T level ≤-3.0SD had a higher re-fracture rate than patients with BMD-T level ＞-3.0SD.Conclusion BMD level was an effective and suitable predictor for re-fracture in patients with OVCF after PKP,and the high risk of re-fracture after PKP should be considered especially when patients' BMD-T level ≤-3.0SD.%目的 探讨骨质疏松性椎体压缩性骨折(OVCF)患者椎体后凸成形术(PKP)后发生再骨折的影响因素,分析骨密度(BMD)对预测骨折再发的临床价值.方法 前瞻性的队列研究纳入我院208例确诊的OVCF并行PKP手术的患者,初次骨折时检测患者骨密度值(BMD)并记录相关临床资料,术后随访2年以上,以患者骨折再发为随访终点事件.采用Kaplan Meier分析及多元Cox回归模型进行骨折再发的危险因素分析,受试者工作特征(ROC)曲线用于评估BMD对骨折再发的预测价值.结果 208例OVCF患者PKP术后2年内出现骨折再发共37例(17.8％).Cox回归分析显示性别、BMD值以及初次双节段骨折是患者骨折再发的独立危险因素.以BMD为预测标准,ROC曲线下面积为0.787,诊断临界点为-3.0SD,灵敏度及特异度分别为83.2％和66.8％.Kaplan-Meier分析结果示BMD-T值＜-3.0 SD的OVCF患者PKP术后骨折再发率较BMD-T值＞-3.0 SD更高(P =0.024).结论 骨密度对OVCF患者PKP术后骨折再发的风险具有重要评估价值,尤其对于BMD-T值≤-3.0SD者,在行PKP术时应充分考虑到其术后骨折再发的高风险性.