经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折后非手术椎体骨折的原因分析

摘要

目的 探讨骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)行经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)后非手术椎体骨折的相关影响因素.方法 回顾性分析2014年1月至2015年12月于深圳市第二人民医院行PKP治疗OVCF的133例(174椎)病人的临床资料,根据有无椎体新发骨折,分为再骨折组与对照组.随访时间为12~18个月,平均为(15.48±2.28)个月,统计分析病人的性别、年龄、身体质量指数(body mass index,BMI)、腰椎骨密度、受伤椎体个数、骨水泥用量、手术入路、骨水泥是否渗透至椎间盘、术后伤椎前缘高度恢复率以及Cobb角恢复率等因素.结果 术后28例(21.05%,28/133)病人再发骨折,再骨折组的平均年龄为(76.32±7.59)岁,5例发生骨水泥渗透至椎间盘(17.86%,5/28),腰椎骨密度T值为(-3.60±0.79)SD,椎体前缘高度恢复率为(50.39±1.87)%,Cobb角恢复率为(53.07±3.91)%,以上指标与未再发骨折的病人比较,差异均有统计学意义(P均<0.05).对以上指标进行多因素Logistic回归分析结果显示仅骨密度与再骨折的发生存在显著相关性(P=0.031).结论 骨密度、年龄、骨水泥向椎间盘渗漏、椎体前缘高度恢复率及Cobb角恢复率是PKP术后出现非手术椎体骨折的相关因素,但术前骨密度是其独立危险因素.%Objective To investigate the related factors associated with non-surgical vertebral centrum fractures after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCF). Methods A retrospective study was performed on 133 patients who had undergone PKP for osteoporotic vertebral compression fractures including 174 centrums from January 2014 to December 2015. According to the follow-up results, the patients were divided into re-fracture group and control group. They obtained an average follow-up period of (15.5±2.28) months (from 12 to 18 months). The patients'gender, age, body mass index (BMI), bone mineral density, injured vertebral number, bone cement dosage, operative approach, leakage of the bone cement to the intervertebral disc, vertebral height restoration rate, and the Cobb restoration rate were recorded and analyzed. Results There were 28 cases of non-surgical vertebral centrum fractures after PKP, accounting for 21.05%. The age in the re-fracture group was (76.32 ± 7.59) years. Five patients had leakage of the bone cement to the intervertebral disc, accounting for 17.86%. The mean of lumbar vertebrae bone mineral density was (-3.60±0.79) SD. The mean of vertebral height restoration rate was (50.39± 1.87)%, and the mean of Cobb restoration rate was (53.07±3.91)%. The difference in the above indicators was statistically significant between re-fracture group and control group (P<0.05 for all). Multi-factor logistic regression analysis revealed that only bone mineral density was strongly associated with the re-fracture incidence. Conclusion In addition to the age and bone mineral density, the leakage of the bone cement to the intervertebral disc, vertebral height restoration rate and the Cobb restoration rate were related to non-surgical vertebral fractures. But bone mineral density was a risk factor for non-surgical vertebral centrum fractures after PKP.