河北医科大学学报 ›› 2025, Vol. 46 ›› Issue (2): 131-136.doi: 10.3969/j.issn.1007-3205.2025.02.002

• • 上一篇    下一篇

PVP治疗骨质疏松性椎体压缩骨折术后邻近椎体再发的危险因素分析

  

  1. 1.河北医科大学第三医院脊柱三科，河北 石家庄 050051；2.河北医科大学第三医院创伤急救中心，河北 石家庄 050051

  • 出版日期:2025-02-25 发布日期:2025-02-27
  • 作者简介:侯丽媛（1987-），女，河北石家庄人，河北医科大学第三医院主管护师，医学学士，从事脊柱外科疾病护理研究。
  • 基金资助:
    河北省青年科技课题(20210648)；河北医科大学创新研究团队项目

Analysis of risk factors for recurrence of adjacent vertebral fracture following percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures

  1. 1.The Third Department of Spine Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China; 2.The Trauma and Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China

  • Online:2025-02-25 Published:2025-02-27

HTML

PDF (PC)

48

摘要： 目的 探讨经皮椎体成形术（percutaneous vertebroplasty,PVP）治疗骨质疏松性胸腰椎椎体压缩骨折（osteoporotic vertebral compression fractures,OVCF）后临近椎体骨折再发的相关危险因素。
方法 选取河北医科大学第三医院接受单侧入路 PVP手术治疗的OVCF患者共312例，并根据术后是否再发骨折分为正常组（n=269）和椎体再骨折组（n=43）。随后统计2组手术指标和术后指标，具体术后指标包括性别、年龄、身高、体重、常住地点（农村/城市）、吸烟、饮酒、糖尿病、高血压、心血管疾病、体重指数；手术相关指标包括手术时间、骨水泥注入量、骨密度（bone mineral density,BMD）、术后椎体压缩率、骨水泥渗漏情况和术后Cobb角等。最后通过使用t或U检验比较2组的连续变量，2组的分类变量使用χ2检验对比分析，其中单变量分析中差异有统计学意义（P＜0.05）的预测因素被纳入Logistic回归分析。对于差异有统计学意义的连续变量，运用受试者工作特征（receiver operating characteristic,ROC）曲线进行分析，以确定最佳临界值。
结果 选取的患者在术后6个月随访期间内有43例患者发生术后再骨折，发病率为13.78%，有31例患者发生骨水泥渗漏，发病率为9.94%。多因素 Logistic 分析表明，BMD＜-3.4 g/cm2（OR=6.638，P=0.008）、骨水泥注入量＞5.6 mL（OR=19.178，P＜0.001）、术后Cobb角＞14 °（OR=18.970，P＜0.001），有骨水泥渗漏（OR=10.715、P=0.002）与邻近椎体再压缩相关，而且是独立危险因素。Hosmer-Lemeshow检验统计方法中似没涉及到这个方法显示出良好的适应性（χ2=4.070，P=0.254）。
结论 PVP术后椎体再骨折的发病率为13.78%。BMD＜-3.4 g/cm2、骨水泥注入量＞5.6 mL、术后Cobb角＞14 °和骨水泥渗漏是椎体再压缩的独立危险因素。在手术过程中注意干预骨水泥注入量临界值，缩小术后Cobb角，系统的抗骨质疏松症治疗可以显著降低椎体成形术后再骨折的发生。


关键词: 骨质疏松性骨折, 复发, 治疗结果

Abstract: Objective To investigate the risk factors associated with the recurrence of adjacent vertebral fractures following percutaneous vertebroplasty (PVP) in the treatment of osteoporotic vertebral compression fractures (OVCF). 
Methods A total of 312 patients who underwent unilateral PVP surgery in the Third Hospital of Hebei Medical University were selected and divided into the normal group (n=269) and the vertebral refracture group (n=43) based on the recurrence of fractures postoperatively. Surgical and postoperative indicators of both groups were statistically analyzed; Postoperative indicators included gender, age, height, weight, residence (rural/urban), smoking, alcohol consumption, diabetes, hypertension, cardiovascular disease, and body mass index (BMI), and related surgical indicators included duration of operation, volume of bone cement injection, bone mineral density (BMD), postoperative vertebral compression rate, bone cement leakage, and postoperative Cobb angle. Continuous variables between the two groups were compared using t or U tests, and categorical variables were analyzed using chi-square tests. Predictors with significant differences in univariate analysis (P＜0.05) were included in multivariate Logistic regression analysis. Receiver operating characteristic (ROC) curves were employed to determine the optimal cutoff values for statistically significant continuous variables (P＜0.05). 
Results During the 6-month follow-up period, 43 patients experienced refractures postoperatively, resulting in an incidence rate of 13.78%. Bone cement leakage occurred in 31 patients, with an incidence rate of 9.94%. Multivariate Logistic regression analysis indicated that BMD < -3.4 g/cm2 (OR=6.638, P=0.008), bone cement injection volume > 5.6 mL (OR=19.178, P＜0.001), postoperative Cobb angle > 14 ° (OR=18.970, P＜0.001), and bone cement leakage (OR=10.715, P=0.002) were associated with the recurrence of adjacent vertebral compression and were independent risk factors. The Hosmer-Lemeshow test demonstrated good model fit (χ2=4.07, P=0.254). 
Conclusion The incidence rate of vertebral refracture after PVP is 13.78%. BMD < -3.4 g/cm2, bone cement injection volume > 5.6 mL, postoperative Cobb angle >14 °, and bone cement leakage are independent risk factors for vertebral re-compression. Attention to the critical threshold of bone cement injection volume during surgery, reduction of the postoperative Cobb angle, and systematic anti-osteoporosis treatment can significantly decrease the incidence of refractures following vertebroplasty. 


Key words: osteoporotic fractures, recurrence, treatment outcome

版权所有 © 《河北医科大学学报》编辑部
本系统由北京玛格泰克科技发展有限公司设计开发