OVCF骨水泥强化术后椎体再骨折影响因素分析
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摘要
目的探讨骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)骨水泥强化治疗术后椎体再骨折的影响因素。方法回顾研究2009年8月至2017年12月在我院脊柱外科随机选择PVP或PKP手术治疗100例OVCF后椎体再骨折患者资料,并随机选择同期100例术后未再骨折患者资料进行对比。比较两组性别、年龄、身体质量指数(body mass index,BMI)、骨密度(bone densitometry,BMD)、椎体强化个数、骨水泥使用量、骨水泥渗漏情况、椎体前柱高度(anterior vertebral height,AVH)恢复率、骨水泥分布情况、手术方式,是否抗骨质疏松治疗,是否合并其他骨折病史,是否长期应用糖皮质激素。结果单因素分析:研究组和对照组性别、年龄、BMI、骨水泥使用量、手术方式、椎体强化个数比较,差异无统计学意义(P>0.05)。但是研究组较对照组骨质疏松更严重,更多病例发生骨水泥椎间盘渗漏、长期应用糖皮质激素和骨水泥分布不均,更大的AVH恢复率,合并其他骨折病史比例更高,行正规抗骨质疏松治疗比例更低(P<0.05)。Logistic回归分析:研究组较对照组长期应用糖皮质激素比例更高、行正规抗骨质疏松治疗比例更低(P<0.05)。结论严重骨质疏松、骨水泥椎间盘渗漏、骨水泥分布不均、过高AVH恢复率、未正规治疗骨质疏松、合并其他骨折、长期应用糖皮质激素,均是导致OVCF骨水泥强化术后椎体再骨折的原因。
Objective To analyze the influencing factors of vertebral body re-fracture after OVCF cement treatment.Methods The data of 100 patients with vertebral body re-fracture treated with bone cement augmentation surgery in spinal surgery in our hospital from August 2009 to December 2017 were retrospectively reviewed.Randomly selected100 patients with no re-fracture after operation in the same period were used for comparison.We compared the gender,age,BMI,BMD,number of vertebral enhancements,bone cement usage,bone cement leakage,AVH recovery rate,bone cement distribution,surgical methods,whether the patients had anti-osteoporosis treatment,other fractures and longterm use of glucocorticoids.Results Univariate analysis showed that there was no significant difference in gender,age,BMI,bone cement usage,surgical methods,and number of vertebral enhancement between the study group and the control group(P>0.05).However,the study group was more severe than the control group in osteoporosis,with more cases of bone cement intervertebral disc leakage,unequal distribution of long-term glucocorticoid and bone cement,greater AVH recovery rate,and a higher proportion of other fractures.The proportion of regular anti-osteoporosis treatment was even lower(P<0.05).Logistic regression analysis showed that the study group had a higher proportion of longterm glucocorticoid treatment,and a lower proportion of regular anti-osteoporosis treatment(P<0.05).ConclusionSevere osteoporosis,bone cement intervertebral disc leakage,uneven distribution of bone cement,excessive AVH recovery rate,irregular treatment of osteoporosis,other combined fractures,long-term use of glucocorticoids,are all causes of postoperative vertebral fractures after OVCF bone cement augmentation.
Objective To analyze the influencing factors of vertebral body re-fracture after OVCF cement treatment.Methods The data of 100 patients with vertebral body re-fracture treated with bone cement augmentation surgery in spinal surgery in our hospital from August 2009 to December 2017 were retrospectively reviewed.Randomly selected100 patients with no re-fracture after operation in the same period were used for comparison.We compared the gender,age,BMI,BMD,number of vertebral enhancements,bone cement usage,bone cement leakage,AVH recovery rate,bone cement distribution,surgical methods,whether the patients had anti-osteoporosis treatment,other fractures and longterm use of glucocorticoids.Results Univariate analysis showed that there was no significant difference in gender,age,BMI,bone cement usage,surgical methods,and number of vertebral enhancement between the study group and the control group(P>0.05).However,the study group was more severe than the control group in osteoporosis,with more cases of bone cement intervertebral disc leakage,unequal distribution of long-term glucocorticoid and bone cement,greater AVH recovery rate,and a higher proportion of other fractures.The proportion of regular anti-osteoporosis treatment was even lower(P<0.05).Logistic regression analysis showed that the study group had a higher proportion of longterm glucocorticoid treatment,and a lower proportion of regular anti-osteoporosis treatment(P<0.05).ConclusionSevere osteoporosis,bone cement intervertebral disc leakage,uneven distribution of bone cement,excessive AVH recovery rate,irregular treatment of osteoporosis,other combined fractures,long-term use of glucocorticoids,are all causes of postoperative vertebral fractures after OVCF bone cement augmentation.
引文
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[10] Burton AW,Mendoza T,Gebhardt R,et al.Vertebral compression fracture treatment with vertebroplasty and kyphoplasty:experience in 407patients with 1,156fractures in a tertiary cancer center[J].Pain Med,2011,12(12):1750-1757.
[11] Chen LH,Hsieh MK,Liao JC,et al.Repeated percutaneous vertebroplasty for refracture of cemented vertebrae[J].Arch Orthop Trauma Surg,2011,131(7):927-933.
[12]李亮,聂艳,姜保恩,等.经皮椎体成形术后手术椎体再发骨折的相关因素分析[J].实用骨科杂志,2014,20(4):339-343.
[2] Uppin AA,Hirsch JA,Centenera LV,et al.Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis[J].Radiology,2003,226(1):119-124.
[3] Heini PF,Orler R.Vertebroplasty in severe osteoporosis.Technique and experience with multi-segment injection[J].Orthopade,2004,33(1):22-30.
[4] Lu K,Liang CL,Hsieh CH,et al.Risk factors of subsequent vertebral compression fractures after vertebroplasty[J].Pain medicine,2012,13(3):376-382.
[5] Zhang Z,Fan J,Ding Q,et al.Risk factors for new osteoporotic vertebral compression fractures after vertebroplasty:a systematic review and meta-analysis[J].J Spinal Disord Tech,2013,26(4):E150-157.
[6] Ma X,Xing D,Ma J,et al.Risk factors for new vertebral compression fractures after percutaneous vertebroplasty:qualitative evidence synthesized from a systematic review[J].Spine,2013,38(12):E713-722.
[7] Lin EP,Ekholm S,Hiwatashi A,et al.Vertebroplasty:cement leakage into the disc increases the risk of new fracture of adjacent vertebral body[J].Am J Neuroradiol,2004,25(2):175-180.
[8] Komemushi A,Tanigawa N,Kariya S,et al.Percutaneous vertebroplasty for osteoporotic compression fracture:multivariate study of predictors of new vertebral body fracture[J].Cardiovasc Intervent Radiol,2006,29(4):580-585.
[9] Siris ES,Genant HK,Laster AJ,et al.Enhanced prediction of fracture risk combining vertebral fracture status and BMD[J].Osteoporos Int,2007,18(6):761-770.
[10] Burton AW,Mendoza T,Gebhardt R,et al.Vertebral compression fracture treatment with vertebroplasty and kyphoplasty:experience in 407patients with 1,156fractures in a tertiary cancer center[J].Pain Med,2011,12(12):1750-1757.
[11] Chen LH,Hsieh MK,Liao JC,et al.Repeated percutaneous vertebroplasty for refracture of cemented vertebrae[J].Arch Orthop Trauma Surg,2011,131(7):927-933.
[12]李亮,聂艳,姜保恩,等.经皮椎体成形术后手术椎体再发骨折的相关因素分析[J].实用骨科杂志,2014,20(4):339-343.