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随着人口老龄化日趋加剧,骨质疏松性胸腰椎压缩性骨折(osteoporotic vertebral compression fracture,OVCF)发病率有逐年上升趋势,对于症状明显者,椎体成形术[经皮穿刺椎体成形术(PVP)或球囊扩张椎体后凸成形术(PKP)]因其创伤小、镇痛迅速、支持老年病人早期下床活动等优点[1-3],已成为治疗的首选方法。然而,PKP术后再骨折很常见,较大宗病例随访结果显示再骨折率达10.2%~15.6%[4-6]。而再骨折原因虽有许多研究但至今仍不十分清楚,本文结合我院临床病例对此进行探讨, 现作报道。
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84例病人术后均获得优良效果,7例次术后残余痛,经局部封闭或对症处理症状渐次缓解。术后均获随访12~57个月。因内科并发症死亡7例,死亡时手术均已超过12个月,死亡前腰痛症状缓解满意。PKP术后再发骨折13例,其中再发骨折1次10例、2次2例、4次1例,共18例次,再骨折部位发生于原骨折椎体(包括前驱陈旧性楔形变椎体)上方或下方相临椎体者12例次,间隔1个椎体者1例次,间隔2个椎体以上远隔椎体者4例次(原胸腰段骨折再发中胸段骨折3例次,再发下腰段骨折1例次),同时再发临椎及远隔椎体者1例次。18例次中,16例次再次入院行PKP术,2例次保守治疗,卧床休息及抗骨质疏松药物等治疗缓解。
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单因素分析发现PKP术后再骨折病人BMI、骨密度均低于未再骨折病人(P<0.01);术前陈旧性椎体楔形变率、术后胸腰椎结构异常率高于未再骨折病人(P<0.05);而性别、年龄、损伤节段数、骨水泥注入方式、每椎体骨水泥注入量、骨水泥椎间渗漏、AVH恢复率和术后后凸畸形角度与未再骨折病人间差异无统计学意义(P>0.05)(见表 1)。
项目 再骨折(n=13) 未再骨折(n=71) χ2 P 性别(男/女) 3/10 12/59 0.20 >0.05 年龄(x±s)/岁 75.69±8.05 74.92±8.55 0.30* >0.05 BMI)/(kg/m2) 22.31±2.89 25.84±5.67 3.37△ <0.01 骨密度(x±s)/(g/cm2) 3.25±0.64 4.23±0.83 4.04* <0.01 损伤节段数(x±s) 1.63±0.73 1.78±0.81 0.62* >0.05 术前有陈旧性椎体楔形变 9(69.23) 26(36.62) 4.81 <0.05 骨水泥注入方式[n;百分率(%)] 单侧 2(11.11) 16(16.49) 0.33 >0.05 双侧 16(88.89) 81(83.51) 每椎体骨水泥注入量(x±s) 4.15±0.96 4.23±0.88 0.30* >0.05 骨水泥椎间渗漏[n;百分率(%)] 1(7.69) 4(5.63) — >0.05# AVH恢复率(x±s) 2.85±0.64 2.67±0.31 0.99* >0.05 术后后凸畸形角度(x±s)/(°) 14.12±1.87 13.17±1.69 1.83* >0.05 术后胸腰椎结构异常[n; 百分率(%)] 0(0.00) 26(36.62) 5.29 <0.05 *示t值;△示t′值;#示Fisher′s确切概率法 表 1 PKP术后再骨折的单因素分析
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进一步logistic回归分析显示,BMI低、骨密度低、术前有陈旧性椎体楔形变及胸腰椎结构异常是术后椎体再骨折的危险因素(P<0.05~P<0.01)(见表 2)。
危险因素 B SE Wald χ2 P OR 95%CI BMI -0.44 0.14 9.18 <0.05 0.64 0.48~0.90 骨密度 -1.89 0.51 12.85 <0.01 0.08 0.08~0.38 椎体有陈旧性楔形变 1.41 0.66 4.57 <0.05 4.08 1.12~14.83 胸腰椎结构异常 -1.83 0.75 5.05 <0.05 0.16 0.04~0.75 表 2 PKP术后再骨折多因素logistic回归分析
骨质疏松性胸腰椎压缩性骨折PKP术后再骨折危险因素分析
Analysis of risk factors of the re-fracture of osteoporotic thoracolumbar compression fractures after PKP
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摘要:
目的探讨骨质疏松性胸腰椎压缩性骨折球囊扩张椎体后凸成形术(PKP)术后再骨折的相关危险因素。 方法回顾分析84例PKP术治疗的胸腰椎骨质疏松性压缩性骨折病人的临床资料,术后均获随访12~57个月;根据病人随访期间是否发生再骨折,将病人分为再骨折组和未再骨折组,对2组病人的性别、年龄、体质量指数、骨密度、损伤节段数量、术前陈旧性楔形变椎体率及受累椎体数、骨水泥注入方式、骨水泥注射量、术后有无椎间盘骨水泥渗漏、椎体前缘高度恢复率、术后后凸畸形角度和胸腰椎结构类型进行对比分析。 结果84例病人术后再骨折13例(18例次)。单因素分析显示,PKP再骨折组体质量指数、骨密度均低于未再骨折组(P<0.01),术前陈旧性椎体楔形变率、术后胸腰椎结构异常率高于未再骨折组(P<0.05)。logistic回归分析显示,体质量指数低、骨密度低、术前有陈旧性椎体楔形变及胸腰椎结构异常是PKP术后再骨折的危险因素(P<0.05~P<0.01)。 结论骨质疏松和胸腰椎结构的损伤程度是诱发骨质疏松性胸腰椎压缩性骨折PKP术后再骨折的危险因素。 -
关键词:
- 压缩性骨折 /
- 胸腰椎 /
- 骨质疏松 /
- 球囊扩张椎体后凸成形术 /
- 再骨折
Abstract:ObjectiveTo explore the risk factors of the refracture of osteoporotic thoracolumbar compression fractures after percutaneous kyphoplasty(PKP). MethodsThe clinical data of 84 osteoporotic thoracolumbar compression fractures patients treated with PKP were retrospectively analyzed.All patients were followed up for 12 to 57 months.The patients were divided into the refracture group and non-refracture group according to the refracture condition.The gender, age, body mass index(BMI), bone mineral density(BMD), number of injured vertebrae, number of cases with wedge-shaped vertebral bodies, number of involved vertebrae, way of bone cement injection, bone cement injection volume, intervertebral disc leakage of bone cement, anterior vertebral height restoration, postoperative kyphosis and structural type of thoracolumbar vertebrae were compared between two groups. ResultsAmong 84 patients, the postoperative secondary fracture in 13 cases(18 times) after PKP were found.The results of univariate analysis showed the BMI and BMD in refracture group were lower than those in non-refracture group(P < 0.01), and the postoperative thoracolumbar structural abnormality rate in refracture group were higher than those in non-refracture group(P < 0.05).The results of logistic regression analysis showed that the body mass index, bone mineral density, preoperative old vertebral wedge-shaped change and postoperative thoracolumbar structural abnormality rate were the high risk factors of postoperative vertebral refracture. ConclusionsThe osteoporosis and degree of thoracolumbar structural injury are the risk factors of osteoporotic thoracolumbar compression fracture after PKP. -
Key words:
- compression fracture /
- thoracolumbar /
- osteoporosis /
- percutaneous kyphoplasty /
- refracture
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表 1 PKP术后再骨折的单因素分析
项目 再骨折(n=13) 未再骨折(n=71) χ2 P 性别(男/女) 3/10 12/59 0.20 >0.05 年龄(x±s)/岁 75.69±8.05 74.92±8.55 0.30* >0.05 BMI)/(kg/m2) 22.31±2.89 25.84±5.67 3.37△ <0.01 骨密度(x±s)/(g/cm2) 3.25±0.64 4.23±0.83 4.04* <0.01 损伤节段数(x±s) 1.63±0.73 1.78±0.81 0.62* >0.05 术前有陈旧性椎体楔形变 9(69.23) 26(36.62) 4.81 <0.05 骨水泥注入方式[n;百分率(%)] 单侧 2(11.11) 16(16.49) 0.33 >0.05 双侧 16(88.89) 81(83.51) 每椎体骨水泥注入量(x±s) 4.15±0.96 4.23±0.88 0.30* >0.05 骨水泥椎间渗漏[n;百分率(%)] 1(7.69) 4(5.63) — >0.05# AVH恢复率(x±s) 2.85±0.64 2.67±0.31 0.99* >0.05 术后后凸畸形角度(x±s)/(°) 14.12±1.87 13.17±1.69 1.83* >0.05 术后胸腰椎结构异常[n; 百分率(%)] 0(0.00) 26(36.62) 5.29 <0.05 *示t值;△示t′值;#示Fisher′s确切概率法 表 2 PKP术后再骨折多因素logistic回归分析
危险因素 B SE Wald χ2 P OR 95%CI BMI -0.44 0.14 9.18 <0.05 0.64 0.48~0.90 骨密度 -1.89 0.51 12.85 <0.01 0.08 0.08~0.38 椎体有陈旧性楔形变 1.41 0.66 4.57 <0.05 4.08 1.12~14.83 胸腰椎结构异常 -1.83 0.75 5.05 <0.05 0.16 0.04~0.75 -
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