经皮椎体成形术及经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折再发骨折危险因素研究

Risk factors of non-surgical vertebral fractures after percutaneous vertebroplasty and percutaneous kyphoplasty for osteoporotic vertebral compression fractures

摘要:

目的 探讨骨质疏松性椎体压缩骨折（OVCFs）经皮椎体成形术（PVP）及经皮椎体后凸成形术（PKP）后非手术椎体骨折的危险因素。方法 回顾性研究2009年2月～2010年3月于河北医科大学第三医院脊柱外科门诊及病房共收治OVCFs患者76例, 男11例, 女65例, 年龄56～87岁, 平均（66.7±7.3）岁, 随访时间6～22个月, 平均13.6个月。44例患者行PVP手术, 32例患者行PKP手术。记录两组患者年龄、性别、病程、体质量指数、骨密度、水泥注入量、水泥渗漏率、平均后凸角矫形, 分析引起非手术椎体骨折的危险因素。结果 PVP组患者水泥注入量及平均后凸角矫形均低于PKP组患者, 经两样本t检验，差异有统计学意义（P＜0.05）; 水泥渗漏率和新发椎体骨折两组间差异无统计学意义（P＞0.05）; logistic回归分析结果显示, 骨密度T值≤－2.5 SD是与非手术椎体骨折相关的危险因素, 后凸角矫形≥5.0° 组患者新发骨折与首次手术间隔时间明显短于对照组, 经秩和检验显示差异有统计学意义（P＜0.05）。结论 骨密度T值≤－2.5SD是与非手术椎体骨折相关的危险因素, 在骨密度T值严重降低的骨质疏松患者中, 过多的矫正后凸畸形可能缩短了再发骨折的发病周期。

Abstract:

Objective To investigate the risk factors associated with non-surgical vertebral fractures after percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCFs). Methods From February 2009 to March 2010, 76 patients with OVCFs were included in this study. There were 11 males and 65 females with the average age of (66.7±7.3) years. The average follow-up time was 13.6 months, ranging from 6 to 22 months. All patients underwent X-Ray and MRI to confirm the onset of vertebral fracture. Forty-four patients underwent PVP and 32 patients PKP. The bone mineral density (BMD) of lumbar spine was measured by dual-energy X-ray absorptiometry, and age, sex, body mass index (BMI), cement volume, cement leakage (%), and kyphosis correction of all patients were recorded. The risk factors associated with the non-surgical vertebral fractures were analyzed. Results Student's t test showed statistically significant differences (P＜0.05) between two groups with respect to cement volume and kyphosis correction. There were no significant differences between cement leakage and new vertebral compression fractures between two groups. Multiple logistic regression analysis showed BMD less than -2.5SD was the only risk factor associated with non-surgical segment fracture. Patients with the kyphosis correction more than 5.0° had a short period to the new vertebral fractures than those whose kyphosis correction were less than 5.0°. Conclusion BMD less than -2.5SD is the risk factor of nonsurgical vertebral fractures after PVP for OVCFs. In those osteoporosis patients with low T values, excess kyphosis correction may follow by a soon onset of non-surgical vertebral fractures.