骨质疏松椎体压缩性骨折患者经皮椎体成形术后再次骨折的危险因素分析

目的:探讨骨质疏松椎体压缩骨折患者接受椎体成形术后再次新发骨折的危险因素。方法:选取2009年1月到2015年1月就诊于我院诊断为骨质疏松椎体压缩性骨折且行经皮椎体成形术的患者,收集患者的诊疗信息及影像学资料。收集患者的年龄、性别等基本资料及基于定量CT测量的骨矿物含量、骨水泥注射占椎体体积的比、骨水泥的分布及骨水泥的渗漏情况。将单椎体骨折且在随访时间内再次新发椎体骨折的患者分为A组,未骨折的患者分为B组,对比分析两组之间的参数的差异,并利用二项Logistic回归分析分析再次骨折的危险因素。结果:共有287例患者纳入研究,平均随访时间为34.7±17.8个月,压缩性骨折最常见的椎体依次为L1(29.1%)、T12(20.8%)及L2(13.5%)。在随访时间内共有32例患者再次发生椎体骨折。252例单椎体骨折患者中,26例(A组)再次发生骨折,226例(B组)未发生骨折。A组骨矿物含量低于B组(P0.001),骨水泥分布较B组差(P0.001),年龄高于B组(P0.001)且骨水泥渗漏发生率(34.6%)高于B组(13.7%)(P=0.006),两组在骨水泥占椎体的比、后凸程度、性别比例没有统计学差异。回归分析显示骨矿物含量(OR=1.092,P0.001)、年龄(OR=1.091,P0.001)及骨水泥渗漏(OR=1.200,P=0.002)均是再次骨折的危险因素,骨水泥的均匀分布是保护因素(OR=0.922,P0.001)。结论:年龄较大且骨质较差的患者容易再次发生椎体骨折,在行椎体成形术过程中应尽量使骨水泥均匀分布并避免骨水泥的渗漏。

Analysis of Risk Factors for Re-fracture after Percutaneous Vertebroplasty in Patients with Osteoporotic Vertebral Compression Fractures

ABSTRACT Objective: To investigate the risk factors for renew fractures after vertebroplasty in patients with osteoporotic vertebral compression fractures. Methods: The patients who were diagnosed as osteoporotic vertebral compression fractures and underwent percu- taneous vertebroplasty in our hospital from January 2009 to January 2015 were selected. The patient''s diagnosis and treatment informa- tion and imaging data were collected. The basic data of the patient''s age, sex, bone mineral content (BMC) based on quantitative CT, ra- tio of bone cement injection to vertebral body volume, bone cement distribution, and bone cement leakage were collected. Patients with a single vertebral fracture and a new vertebral fracture within the follow-up period were divided into group A. Patients with no fracture were divided into group B. The differences in parameters between the two groups were analyzed and risk factors were analyzed for sec- ondary fractures using binomial logistic regression analysis. Results: A total of 287 patients were included in the study. The average fol- low-up time was 34.7±17.8 months. The most common vertebral bodies for compression fractures were L1 (29.1 %), T12 (20.8 %), and L2 (13.5 %). A total of 32 patients had recurrent vertebral fractures during the follow-up period. In 252 patients with single vertebral frac- tures, 26 (Group A) fractures occurred again, and 226 (Group B) did not. The BMC in group A was lower than that in group B (P<0.001), and the bone cement distribution was worse than that in group B (P<0.001). The age in group A was higher than that in group B (P<0.001) and the rate of bone cement leakage (34.6 %) was higher than that in group B (13.7 %) (P=0.006). There was no statistical differ- ence between the two groups in the proportion of bone cement in the vertebral body, the degree of kyphosis, and the sex ratio. Regres- sion analysis showed that BMC (OR=1.092, P<0.001), age (OR=1.091, P<0.001) and bone cement leakage (OR=1.200, P=0.002) were all risk factors for fracture again. The uniform distribution of bone cement was a protective factor (OR=0.922, P<0.001). Conclusion: Older patients with poor bone quality are prone to vertebral fractures again. During vertebroplasty, the bone cement should be distributed as evenly as possible and leakage of bone cement should be avoided.