[1]姚敏刚,马晓飞,孔明祥.单节段骨质疏松性椎体压缩骨折经皮椎体后凸成形术后再骨折的危险因素分析[J].中医正骨,2024,36(12):14-19.
　YAO Mingang,MA Xiaofei,KONG Mingxiang.Risk factors for refracture after percutaneous kyphoplasty in patients with mono-segmental osteoporotic vertebral compression fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2024,36(12):14-19.
点击复制

单节段骨质疏松性椎体压缩骨折经皮椎体后凸成形术后再骨折的危险因素分析()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期数:
2024年12期
页码:
14-19
栏目:
临床研究
出版日期:
2024-12-20

文章信息/Info

Title:
Risk factors for refracture after percutaneous kyphoplasty in patients with mono-segmental osteoporotic vertebral compression fractures
作者:
姚敏刚1; 马晓飞1; 孔明祥2
1.杭州市余杭区第二人民医院,浙江 杭州 311121; 2.浙江省人民医院,浙江 杭州 310014
Author(s):
YAO Mingang1; MA Xiaofei1; KONG Mingxiang2
1.The Second People's Hospital of Yuhang District,Hangzhou 311121,Zhejiang,China 2.Zhejiang Provincial People's Hospital,Hangzhou 310014,Zhejiang,China
关键词:
骨质疏松性骨折;  脊柱骨折;  骨折; 压缩性;  后凸成型术;  危险因素
Keywords:
osteoporotic fractures;  spinal fractures;  fractures; compression;  kyphoplasty;  risk factors
摘要:
目的:分析单节段骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCF)经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)后再骨折的危险因素。方法:回顾性分析采用PKP治疗的单节段OVCF患者的病例资料,提取性别、年龄、体质量指数(body mass index,BMI)、骨密度T值、骨折节段、是否合并高血压、是否合并糖尿病、是否合并脊柱侧弯、术前Cobb角、骨水泥注射量、骨水泥渗漏情况、骨水泥分布情况(是否超过椎体中线)、术后是否抗骨质疏松治疗、椎体高度恢复率、术后Cobb角等信息。根据术后是否出现再骨折,将纳入研究的患者分为再骨折组和无骨折组。先对2组患者的相关信息进行单因素分析,再采用多因素Logistic回归分析单节段OVCF患者PKP后再骨折的危险因素。结果:共纳入患者289例,其中再骨折组39例、无骨折组250例。单因素分析结果显示,2组患者性别、是否合并高血压、是否合并糖尿病、是否合并脊柱侧弯、骨水泥注射量、骨水泥渗漏情况、骨水泥分布情况、术后Cobb角比较,组间差异均无统计学意义。2组患者年龄、BMI、骨密度T值、骨折节段、术前Cobb角、术后是否抗骨质疏松治疗、椎体高度恢复率比较,组间差异均有统计学意义。多因素Logistic回归分析结果显示,骨密度T值、术后是否抗骨质疏松治疗和椎体高度恢复率是PKP术后再骨折的影响因素(β=-0.407,P=0.021,OR=0.665; β=-0.900,P=0.042,OR=0.407; β=0.054,P=0.001,OR=1.056)。Hosmer-Lemeshow检验结果显示,回归模型对数据拟合度较好(χ2=7.415,P=0.493)。采用软件制作骨密度T值和椎体高度恢复率的非限制性立方样条图,在上面寻找导致PKP术后再骨折风险增加的截点。确定的截点表明,骨密度T值<-2.6、椎体高度恢复率>9.8%是PKP术后再骨折的危险因素。结论:骨密度T值<-2.6、术后未进行抗骨质疏松治疗和椎体高度恢复率>9.8%是单节段OVCF患者PKP术后再骨折的危险因素。
Abstract:
Objective:To analyze the risk factors for refracture after percutaneous kyphoplasty(PKP)in patients with mono-segmental osteoporotic vertebral compression fractures(OVCF).Methods:The medical records of patients who underwent PKP for mono-segmental OVCF were selected and retrospectively analyzed.The information of the included patients,including gender,age,body mass index(BMI),bone mineral density(BMD)T-score,fractured segment,whether combined with hypertension,diabetes mellitus,and spinal scoliosis,pre-operative Cobb's angle,consumption of bone cement,leakage of bone cement,distribution of bone cement(whether diffusing beyond the midline of the vertebral body),whether underwent anti-osteoporosis treatment after PKP,vertebral height restoration rate,postoperative Cobb's angle,was extracted from the Electronic Medical Record System(EMRS).The included patients were divided into refracture group and non-refracture group according to whether the refracture was found after PKP.A single-factor analysis was conducted on the extracted information of patients in the 2 groups to screen the factors with statistically significant differences between the 2 groups,followed by a multi-factor logistic regression analysis on the screened factors to identify the risk factors for refracture after PKP in mono-segmental OVCF patients.Results:Two hundred and eighty-nine patients were enrolled in the study,39 ones in the refracture group and 250 ones in the non-refracture group.The single factor analysis showed that the differences were not statistically significant between the 2 groups in gender,whether combined with hypertension,diabetes mellitus,and spinal scoliosis,consumption of bone cement,leakage of bone cement,distribution of bone cement,and postoperative Cobb's angle,while,were statistically significant in the rest factors.The multi-factor logistic regression analysis revealed that the BMD T-score,whether underwent anti-osteoporosis treatment after PKP,and vertebral height restoration rate were the influencing factors of refracture after PKP in mono-segmental OVCF patients(β=-0.407,P=0.021,OR=0.665; β=-0.900,P=0.042,OR=0.407; β=0.054,P=0.001,OR=1.056).Furthermore,the goodness-of-fit(GOF)of the logistic regression model was assessed by using Hosmer-Lemeshow(HL)test,and the results showed the model had a good GOF(χ2=7.415,P=0.493).In addition,the unrestricted cubic spline(UCS)curves were made based on BMD T-score and vertebral height restoration rate by using R4.22 software to determine the cut-off points that increased the risk of refracture after PKP,and the results indicated that a BMD T-score<-2.6 and a vertebral height restoration rate>9.8% were the risk factors for refracture after PKP in mono-segmental OVCF patients.Conclusion:A BMD T-score<-2.6,no postoperative anti-osteoporosis treatment,and a vertebral height restoration rate>9.8% are the risk factors for refracture after PKP in mono-segmental OVCF patients.

参考文献/References:

[1] SCHLAICH C,MINNE H W,BRUCKNER T,et al.Reduced pulmonary function in patients with spinal osteoporotic fractures[J].Osteoporos Int,1998,8(3):261-267.
[2] FEHLINGS M G.The safety of percutaneous vertebroplasty and kyphoplasty[J].J Neurosurg Spine,2009,11(5):605-606.
[3] LI Y X,GUO D Q,ZHANG S C,et al.Risk factor analysis for re-collapse of cemented vertebrae after percutaneous vertebroplasty(PVP)or percutaneous kyphoplasty(PKP)[J].Int Orthop,2018,42(9):2131-2139.
[4] GAO W,CHEN Y,WANG X,et al.Establishment and verification of a predictive nomogram for new vertebral compression fracture occurring after bone cement injection in middle-aged and elderly patients with vertebral compression fracture[J].Orthop Surg,2023,15(4):961-972.
[5] DAI C,LIANG G,ZHANG Y,et al.Risk factors of vertebral re-fracture after PVP or PKP for osteoporotic vertebral compression fractures,especially in Eastern Asia:a systematic review and meta-analysis[J].J Orthop Surg Res,2022,17(1):161.
[6] CHEN Z,SONG C,LIN H,et al.Does prophylactic vertebral augmentation reduce the refracture rate in osteoporotic vertebral fracture patients:a meta-analysis[J].Eur Spine J,2021,30(9):2691-2697.
[7] 李耀,吴爱悯,林焱,等.骨质疏松性胸腰椎压缩骨折椎体成形术后残余背痛影响因素的研究进展[J].中华创伤杂志,2021,37(10):955-960.
[8] FENG L,FENG C,CHEN J,et al.The risk factors of vertebral refracture after kyphoplasty in patients with osteoporotic vertebral compression fractures:a study protocol for a prospective cohort study[J].BMC Musculoskelet Disord,2018,19(1):195.
[9] 中华医学会骨质疏松和骨矿盐疾病分会.原发性骨质疏松症诊疗指南(2022)[J].中国全科医学,2023,26(14):1671-1691.
[10] GRIFFONI C,LUKASSEN J N M,BABBI L,et al.Percutaneous vertebroplasty and balloon kyphoplasty in the treatment of osteoporotic vertebral fractures:a prospective randomized comparison[J].Eur Spine J,2020,29(7):1614-1620.
[11] HINDE K,MAINGARD J,HIRSCH J A,et al.Mortality outcomes of vertebral augmentation(vertebroplasty and/or balloon kyphoplasty)for osteoporotic vertebral compression fractures:a systematic review and meta-analysis[J].Radi-ology,2020,295(1):96-103.
[12] 詹子浩,李然,傅栋铭,等.单节段胸腰椎骨质疏松性骨折经皮椎体后凸成形术后其他椎体新发骨折的影响因素分析[J].中国脊柱脊髓杂志,2022,32(12):1095-1101.
[13] 李庆达,柴鑫,贺宝荣.骨质疏松性胸腰椎骨折椎体强化术后伤椎再骨折的危险因素及对策探讨[J].中华创伤杂志,2022,38(12):1071-1076.
[14] 安忠诚,陈晨,董黎强,等.经皮椎体后凸成形术后邻近节段再骨折的危险因素分析[J].中华全科医学,2022,20(4):591-593.
[15] YANG S,LIU Y,YANG H,et al.Risk factors and correlation of secondary adjacent vertebral compression fracture in percutaneous kyphoplasty[J].Int J Surg,2016,36(Pt A):138-142.
[16] QI H,QI J,GAO J,et al.The impact of bone mineral density on bone metabolism and the fracture healing process in elderly chinese patients with osteoporotic vertebral compression fractures[J].J Clin Densitom,2021,24(1):135-145.
[17] 李杨,杜怡斌,刘艺明,等.椎体后凸成形注射自固化磷酸钙骨水泥后高龄及应力改变为再发骨折的危险因素[J].中国组织工程研究,2022,26(28):4507-4513.
[18] LI Q,LONG X,WANG Y,et al.Development and validation of a nomogram for predicting the probability of new vertebral compression fractures after vertebral augmentation of osteoporotic vertebral compression fractures[J].BMC Musculoskelet Disord,2021,22(1):957.
[19] REID I R,BILLINGTON E O.Drug therapy for osteoporosis in older adults[J].Lancet,2022,399(10329):1080-1092.
[20] COSMAN F.Anabolic therapy and optimal treatment sequences for patients with osteoporosis at high risk for fracture[J].Endocr Pract,2020,26(7):777-786.
[21] CUMMINGS S R,SAN MARTIN J,MCCLUNG M R,et al.Denosumab for prevention of fractures in postmenopausal women with osteoporosis[J].N Engl J Med,2009,361(8):756-765.
[22] BONE H G,BOLOGNESE M A,YUEN C K,et al.Effects of denosumab treatment and discontinuation on bone mineral density and bone turnover markers in postmenopausal women with low bone mass[J].J Clin Endocrinol Metab,2011,96(4):972-980.
[23] YU W,XU W,JIANG X,et al.Risk factors for recollapse of the augmented vertebrae after percutaneous vertebral augmentation:a systematic review and meta-analysis[J].World Neurosurg,2018,111:119-129.
[24] ZHU S,SU Q,ZHANG Y,et al.Risk factors of cemented vertebral refracture after percutaneous vertebral augmentation:a systematic review and meta-analysis[J].Neuroradiology,2020,62(11):1353-1360.
[25] HEO D H,CHIN D K,YOON Y S,et al.Recollapse of previous vertebral compression fracture after percutaneous vertebroplasty[J].Osteoporos Int,2009,20(3):473-480.
[26] 吴俊涛,张春旺,卢绪章.经皮椎体成形术中伤椎高度矫正情况与术后再发邻椎骨折的相关性分析[J].颈腰痛杂志,2020,41(5):617-619.
[27] MILLS E S,HAH R J,FRESQUEZ Z,et al.Secondary fracture rate after vertebral osteoporotic compression fracture is decreased by anti-osteoporotic medication but not increased by cement augmentation[J].J Bone Joint Surg Am,2022,104(24):2178-2185.
[28] BARTON D W,BEHREND C J,CARMOUCHE J J.Rates of osteoporosis screening and treatment following vertebral fracture[J].Spine J,2019,19(3):411-417.
[29] 贺园,张小卫,李新友,等.急性症状性胸腰椎骨质疏松性压缩骨折椎体强化术后伤椎再骨折的危险因素分析[J].中华创伤杂志,2022,38(6):538-544.
[30] ANAM A K,INSOGNA K.Update on osteoporosis screening and management[J].Med Clin North Am,2021,105(6):1117-1134.

相似文献/References:

[1]张亮,张莉,王莉佳,等.快速康复外科理念在椎弓根螺钉内固定治疗 胸腰椎骨折围手术期护理中的应用[J].中医正骨,2015,27(06):75.
[2]潘雄,刘其顺,应行,等.中药联合4步康复锻炼法对骨质疏松性椎体压缩 骨折患者生存质量的影响[J].中医正骨,2015,27(04):65.
[3]宋永枝,陈双玲.唑来膦酸静脉滴注联合鲑降钙素肌肉注射治疗 骨质疏松性长骨骨折[J].中医正骨,2016,28(01):70.
[4]孙兰芬,王龙强,刘润宏,等.颈椎骨折脱位合并脊髓损伤截瘫患者的围手术期护理[J].中医正骨,2016,28(03):79.
[5]吴鹏,王博,孔令成,等.强骨饮颗粒联合阿仑膦酸钠维D3片口服在原发性骨质疏松性髋部骨折术后抗骨质疏松治疗中的应用[J].中医正骨,2016,28(05):16.
　WU Peng,WANG Bo,KONG Lingcheng,et al.Oral application of Qiangguyin Keli(强骨饮颗粒)and alendronate sodium Vitamin D3 tablets in postoperative anti-osteoporosis treatment in patients with primary osteoporotic hip fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(12):16.
[6]梅 伟.胸腰椎骨折临床诊疗中的热点问题[J].中医正骨,2016,28(07):1.
[7]徐无忌,刘晓岚.体位复位结合经皮椎体成形术与经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的对比研究[J].中医正骨,2016,28(07):20.
　XU Wuji,LIU Xiaolan.Effect of Qianggu Yin(强骨饮,QGY)on bone microstructure in the ovariectomized osteoporosis rats[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(12):20.
[8]李英周,叶锋,王晓,等.后路撬拨植骨椎弓根螺钉内固定治疗胸腰椎骨折[J].中医正骨,2016,28(07):46.
[9]王军,陈哲,王硕凡.胸腰椎骨折椎体植骨材料的临床应用进展[J].中医正骨,2016,28(07):64.
[10]史晓林,王健,王博,等.脆性骨折的防治进展[J].中医正骨,2017,29(05):20.
[11]陈建德,樊晓琦,夏炳江,等.球囊扩张部位对椎体后凸成形术治疗骨质疏松性椎体压缩骨折疗效及安全性的影响[J].中医正骨,2017,29(02):11.
　CHEN Jiande,FAN Xiaoqi,XIA Bingjiang,et al.Influence of balloon dilation position on curative effect and safety of percutaneous kyphoplasty for treatment of osteoporotic vertebral compression fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(12):11.
[12]丁志清,颜峰,喻灿明,等.椎体后凸成形术后非典型骨水泥植入综合征死亡1例[J].中医正骨,2017,29(11):76.
[13]俞兴,王婷,杨济洲,等.经皮椎体成形术和经皮椎体后凸成形术治疗Kmmell病的对比研究[J].中医正骨,2018,30(06):23.
　YU Xing,WANG Ting,YANG Jizhou,et al.A retrospective trial of percutaneous vertebroplasty versus percutaneous kyphoplasty for treatment of Kmmell's diseases[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(12):23.
[14]彭小东,张晓刚,赵文韬,等.有限元分析在过伸复位治疗骨质疏松性椎体压缩性骨折生物力学研究中的应用进展[J].中医正骨,2018,30(07):25.
[15]陈建德,樊晓琦,凌义龙.单侧椎弓根旁外侧入路与双侧椎弓根入路 经皮椎体后凸成形术治疗骨质疏松性胸椎 压缩性骨折的对比研究[J].中医正骨,2018,30(10):19.
　CHEN Jiande,FAN Xiaoqi,LING Yilong.A retrospective trial of percutaneous kyphoplasty through unilateral extrapedicular approach versus bilateral transpedicular approach for treatment of thoracic osteoporotic vertebral compression fracture[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(12):19.
[16]于东方,王祥善,张华,等.经皮椎体成形术后手术椎体再骨折的病因、治疗及预防[J].中医正骨,2018,30(10):69.
[17]李兆勇,杨少锋,张晨阳.补肾活血方联合经皮椎体强化术治疗骨质疏松性椎体压缩骨折的系统评价[J].中医正骨,2019,31(03):28.
　LI Zhaoyong,YANG Shaofeng,ZHANG Chenyang.Oral application of Bushen Huoxue Fang(补肾活血方)combined with percutaneous vertebral augmentation for treatment of osteoporotic vertebral compression fractures:a systematic review[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(12):28.
[18]杨磊,崔宏勋,饶耀剑,等.弯角穿刺椎体成形装置辅助下单侧穿刺经皮椎体成形术治疗骨质疏松性椎体压缩骨折[J].中医正骨,2020,32(01):64.
[19]陈晨,安忠诚,张英健,等.椎体强化术后残留腰背痛的研究进展[J].中医正骨,2020,32(05):26.
[20]刘锐,龚德飞,班正涛,等.经皮椎体成形术治疗骨质疏松性椎体压缩骨折术中骨水泥渗漏的危险因素分析[J].中医正骨,2022,34(11):14.
　LIU Rui,GONG Defei,BAN Zhengtao,et al.Risk factors for bone cement leakage during percutaneous vertebroplasty treatment of osteoporotic vertebral compression fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(12):14.

备注/Memo

备注/Memo:
通讯作者:孔明祥 E-mail:kongmingxiang@hmc.edu.cn
更新日期/Last Update: 1900-01-01