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[1]姚敏剛,馬曉飛,孔明祥.單節(jié)段骨質(zhì)疏松性椎體壓縮骨折經(jīng)皮椎體后凸成形術(shù)后再骨折的危險(xiǎn)因素分析[J].中醫(yī)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.
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單節(jié)段骨質(zhì)疏松性椎體壓縮骨折經(jīng)皮椎體后凸成形術(shù)后再骨折的危險(xiǎn)因素分析()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期數(shù):
2024年12期
頁(yè)碼:
14-19
欄目:
臨床研究
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:
姚敏剛1; 馬曉飛1; 孔明祥2
1.杭州市余杭區(qū)第二人民醫(yī)院,浙江 杭州 311121; 2.浙江省人民醫(yī)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
關(guān)鍵詞:
骨質(zhì)疏松性骨折;  脊柱骨折;  骨折; 壓縮性;  后凸成型術(shù);  危險(xiǎn)因素
Keywords:
osteoporotic fractures;  spinal fractures;  fractures; compression;  kyphoplasty;  risk factors
摘要:
目的:分析單節(jié)段骨質(zhì)疏松性椎體壓縮骨折(osteoporotic vertebral compression fractures,OVCF)經(jīng)皮椎體后凸成形術(shù)(percutaneous kyphoplasty,PKP)后再骨折的危險(xiǎn)因素。方法:回顧性分析采用PKP治療的單節(jié)段OVCF患者的病例資料,提取性別、年齡、體質(zhì)量指數(shù)(body mass index,BMI)、骨密度T值、骨折節(jié)段、是否合并高血壓、是否合并糖尿病、是否合并脊柱側(cè)彎、術(shù)前Cobb角、骨水泥注射量、骨水泥滲漏情況、骨水泥分布情況(是否超過椎體中線)、術(shù)后是否抗骨質(zhì)疏松治療、椎體高度恢復(fù)率、術(shù)后Cobb角等信息。根據(jù)術(shù)后是否出現(xiàn)再骨折,將納入研究的患者分為再骨折組和無骨折組。先對(duì)2組患者的相關(guān)信息進(jìn)行單因素分析,再采用多因素Logistic回歸分析單節(jié)段OVCF患者PKP后再骨折的危險(xiǎn)因素。結(jié)果:共納入患者289例,其中再骨折組39例、無骨折組250例。單因素分析結(jié)果顯示,2組患者性別、是否合并高血壓、是否合并糖尿病、是否合并脊柱側(cè)彎、骨水泥注射量、骨水泥滲漏情況、骨水泥分布情況、術(shù)后Cobb角比較,組間差異均無統(tǒng)計(jì)學(xué)意義。2組患者年齡、BMI、骨密度T值、骨折節(jié)段、術(shù)前Cobb角、術(shù)后是否抗骨質(zhì)疏松治療、椎體高度恢復(fù)率比較,組間差異均有統(tǒng)計(jì)學(xué)意義。多因素Logistic回歸分析結(jié)果顯示,骨密度T值、術(shù)后是否抗骨質(zhì)疏松治療和椎體高度恢復(fù)率是PKP術(shù)后再骨折的影響因素(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檢驗(yàn)結(jié)果顯示,回歸模型對(duì)數(shù)據(jù)擬合度較好(χ2=7.415,P=0.493)。采用軟件制作骨密度T值和椎體高度恢復(fù)率的非限制性立方樣條圖,在上面尋找導(dǎo)致PKP術(shù)后再骨折風(fēng)險(xiǎn)增加的截點(diǎn)。確定的截點(diǎn)表明,骨密度T值<-2.6、椎體高度恢復(fù)率>9.8%是PKP術(shù)后再骨折的危險(xiǎn)因素。結(jié)論:骨密度T值<-2.6、術(shù)后未進(jìn)行抗骨質(zhì)疏松治療和椎體高度恢復(fù)率>9.8%是單節(jié)段OVCF患者PKP術(shù)后再骨折的危險(xiǎn)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.

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通訊作者:孔明祥 E-mail:[email protected]
更新日期/Last Update: 1900-01-01