骨质疏松患者经皮球囊扩张椎体后凸成形术后邻近椎体再骨折的风险因素分析

摘要

目的 探讨骨质疏松患者经皮球囊扩张椎体后凸成形术后邻近椎体再骨折的风险因素.方法 回顾性收集2014年6月至2017年6月本院收治的298例骨质疏松性椎体压缩性骨折患者,根据PKP术后是否发生邻近椎体再骨折将患者分为再骨折组与未再骨折组,比较两组患者的性别、年龄、体质指数(BMI)、手术部位、骨水泥注入方式、术前椎体内是否合并裂隙样变、椎体前缘高度(AVH)恢复率、术前骨密度(BMD)、骨水泥注入量、骨水泥渗漏情况以及后凸角变化情况.结果 本研究共298例患者,平均随访(28.74±4.81)个月,发现37例患者术后邻近椎体再骨折,发生率为12.42％;单因素分析结果显示,再骨折组与未再骨折组的性别、BMI、手术部位、骨水泥注入方式、术前椎体内是否合并裂隙样变、AVH恢复率比较,差异均无统计学意义(均P＞0.05);再骨折组与未再骨折组年龄、BMD、骨水泥注入量、骨水泥渗漏情况以及后凸角变化比较,差异均有统计学意义(均P＜ 0.05);多因素分析结果显示,BMD、骨水泥注入量、骨水泥渗漏是再骨折的危险因素,差异均有统计学意义(均P＜0.05).结论 骨质疏松患者PKP术后有一定的邻近椎体再骨折风险,临床应重视此类患者BMD、骨水泥注入量、骨水泥渗漏等情况变化,并予以针对性干预处理,以降低PKP术后再骨折发生率.%Objective To investigate the risk factors of the re-fracture of adjacent vertebral body after percutaneous kyphoplasty with percutaneous balloon dilatation for patients with osteoporosis.Methods The clinical data of 298 patients with osteoporotic vertebral compression fractures treated at our hospital from June,2014 to June,2017 were retrospectively collected.The patients were divided into a re-fracture group and a nonre-fracture group according to the adjacent vertebral fracture after PKP.The gender,age,body mass index (BMI),operative site,the injection method of bone cement,the preoperative intravertebral cleft,height restoration of anterior vertebral body,preoperative bone mineral density (BMD),the amount of bone cement injection,bone cement leakage,and changes of kyphotic angle before and after operation were compared between these two groups.Results In this study,the 298 patients were followed up for (28.74±4.81) months.It was found that 37 patients had re-fracture of the adjacent vertebral body after operation,with an incidence of 12.42％.Univariate analysis showed that there were no statistical differences in gender,BMI,operative site,the injection method of bone cement,the combination of fracture-like changes in the vertebral body before the operation,and the recovery rate of the anterior edge of the vertebral body (all P ＞ 0.05),but were in age,BMD,amount of bone cement injection,bone cement leakage,and kyphotic angle changes between the re-fracture group and the non-re-fracture group (all P ＜ 0.05).Multivariate logistic regression analysis showed that BMD,bone cement injection,and the cement leakage were risk factors of re-fracture (all P ＜ 0.05).Conclusions Osteoporotic patients after PKP have certain risk of adjacent vertebral body re-fracture;the changes such as BMD,bone cement injection,cement leakage in these patients should be paid more attention clinically;and the targeted intervention should be given,so as to reduce the incidence of re-fracture after PKP.