单节段经皮椎体成形术后继发相邻椎体骨折的危险因素

摘要

目的 探讨经皮椎体成形术 (PVP) 治疗单节段骨质疏松性椎体压缩性骨折 (OVCF) 术后继发相邻椎体骨折的危险因素.方法 回顾性分析2013年3月—2017年3月在宁波市第二医院骨科因单节段OVCF行PVP治疗的140例患者的临床资料, 以术后是否继发相邻椎体骨折将患者分为继发骨折组 (A组, 38例) 和无继发骨折组 (B组, 102例) .记录所有患者术后继发相邻椎体骨折的潜在影响因素, 包括非手术因素 (年龄、性别、体质量指数、椎体骨密度、楔形角范围、骨折位置、有无外力参与、是否合并糖尿病、是否有糖皮质激素治疗史) 和手术因素 (骨水泥填充材料、注入量、注入方式、渗漏情况) , 采用独立样本t检验和χ2检验分析以上因素组间差异是否具有统计学意义, 并对差异有统计学意义的因素采用Logistic回归分析评价其与术后相邻椎体骨折的相关性.结果 组间比较, 椎体骨密度、楔形角范围、骨折位置、有无糖皮质激素治疗史及有无外力参与5个方面差异有统计学意义 (P <0.05) , 纳入相关分析;其余统计数据组间差异无统计学意义.Logistic回归分析显示上述5个指标进入方程, 与术后相邻椎体骨折具有相关性.结论 椎体骨密度低、楔形角≥15°、骨折位于胸腰交界处、有糖皮质激素治疗史及外力作用5个指标是术后继发相邻椎体骨折的影响因素, 手术因素不会增加继发相邻椎体骨折风险.%Objective To investigate risk factors of percutaneous vertebroplasty (PVP) for the treatment of adjacent vertebral fractures after single-segment osteoporotic vertebral compression fracture (OVCF) . Methods From March 2013 to March 2017, the clinical data of 140 patients with single-segment OVCF treated by PVP in Ningbo No.2 Hospital were analyzed retrospectively. The patients were divided into 2 groups according to whether with adjacent vertebral fracture after treatment:38 patients in secondary fracture group (Group A) and 102 in non-secondary fracture group (Group B) . Potential factors influencing adjacent vertebral fractures in all patients were recorded, including non-operative factors (gender, age, body mass index, vertebral bone density, wedge angle, fracture site, external force, history of diabetes mellitus and glucocorticoid therapy) and surgical factors (bone cement filling material, bone cement dosage, surgical approach, leakage of bone cement) . The t test and chi-square test were used to analyze whether the differences in above factors between the 2 groups were statistically significant. Logistic regression analysis was used to evaluate the correlation between statistically significant factors and postoperative adjacent vertebral fracture. Results There were statistically significant differences between the 2 groups in vertebral bone density, wedge angle, fracture site, history of diabetes mellitus and glucocorticoid therapy, and participation of external forces (P < 0.05) , which were included in correlation analysis. There was no statistically significant difference between the 2 groups in other statistical data. Logistic regression analysis showed that 5 statistically significant factors of the 2 groups entered the equation, which were associated with postoperative adjacent vertebral fracture. Conclusion Vertebral bone density, wedge angle, fracture site, history of diabetes mellitus and glucocorticoid therapy, and participation of external forces are the factors influencing postoperative adjacent vertebral fractures. Surgical factors do not increase the risk of postoperative adjacent vertebral fractures.