| 单节段胸腰段骨折经皮后凸成形术后再骨折的风险因素分析 |
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Received:March 20, 2017
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| 作者 | Author | 单位 | Unit | E-Mail |
| 吴健 |
WU Jian |
常熟市第二人民医院脊柱外科, 江苏 常熟 215500 |
Department of Spinal Surgery, the Second People's Hospital of Changshu City, Changshu 215500, Jiangsu, China |
1804445708@qq.com |
| 关月红 |
GUAN Yue-hong |
常熟市第二人民医院康复科, 江苏 常熟 215500 |
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| 范胜利 |
FAN Sheng-li |
常熟市第二人民医院脊柱外科, 江苏 常熟 215500 |
Department of Spinal Surgery, the Second People's Hospital of Changshu City, Changshu 215500, Jiangsu, China |
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| 期刊信息：《中国骨伤》2017年30卷，第9期，第833-837页 |
| DOI：10.3969/j.issn.1003-0034.2017.09.010 |
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目的：探讨单节段胸腰段骨质疏松性椎体压缩骨折经皮后凸成形术（percutaneous kyphoplasty，PKP）后非手术椎体再骨折的风险因素。
方法：回顾性分析2010年1月至2015年12月经皮后凸成形术治疗单节段胸腰段骨质疏松性椎体压缩骨折219例患者的临床资料。非手术椎体再骨折组29例，男7例，女22例，年龄（67.35±9.92）岁，骨密度（-3.89±0.72）SD，骨折压缩程度（0.57±0.35）%，骨水泥注入量（4.53±1.64）ml，椎体高度恢复程度（0.49±0.86）%，10例椎体裂隙骨折，7例骨水泥渗漏至椎间盘，9例骨水泥渗漏至外周组织，14例术后系统抗骨质疏松治疗。非手术椎体未骨折组190例，男42例，女148例，年龄（66.98±7.55）岁，骨密度（-3.13±0.59）SD，骨折压缩程度（0.39±0.60）%，骨水泥注入量（4.72±1.28）ml，椎体高度恢复程度（0.46±0.94）%，13例椎体裂隙骨折，5例骨水泥渗漏至椎间盘，29例骨水泥渗漏至外周组织，129例术后系统抗骨质疏松治疗。对两组患者的性别、年龄、骨折压缩程度、骨折类型、骨密度、骨水泥注入量、骨水泥渗漏情况、椎体高度恢复程度、是否相邻椎体骨折、术后是否系统抗骨质疏松治疗等因素作单因素分析，对于有显着性差异的因素，应用多因素Logistic回归分析研究非手术椎体再骨折的风险因素。
结果：219例单节段胸腰段骨折患者中，29例出现非手术椎体再骨折。单因素分析示非手术椎体再骨折组及未骨折组年龄、性别、骨折压缩程度、骨水泥注入量及椎体高度恢复程度无明显相关性（P>0.05），而患者骨折类型、骨水泥渗漏、系统抗骨质疏松治疗、骨密度与术后发生非手术椎体再骨折有相关性（P<0.05）.多因素Logistic回归分析显示：骨折类型（OR=0.135）、是否系统抗骨质疏松治疗（OR=3.793）、骨水泥椎间盘渗漏（OR=8.975）、骨密度（OR=57.079）是导致术后发生非手术椎体再骨折的危险因素。
结论：提高国民身体素质、系统预防及治疗骨质疏松、改善手术技巧、减少术中骨水泥渗漏是预防术后非手术椎体再骨折的有效方法。 |
| [关键词]:经皮后凸成形术 脊柱骨折 骨质疏松 危险因素 |
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| Risk factors of non-surgical vertebral fracture after percutaneous kyphoplasty of single segment thoracolumbar fracture |
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Abstract:
Objective: To investigate the risk factors of non-surgical vertebral fracture after percutaneous kyphoplasty (PKP) in patients with single segment thoracolumbar osteoporotic vertebral compression fracture(OVCF).
Methods: The clinical data of 219 patients with single segment thoracolumbar osteoporotic vertebral compression fracture underwent percutaneous kyphoplasty from January 2010 to December 2015 were retrospectively analyzed. There were 29 cases in non-surgical vertebral body fracture group with 7 males and 22 females aged (67.35±9.92) years. Bone mineral density was(-3.89±0.72)SD,fracture compressed degree was (0.57±0.35)%,bone cement injected volume was (4.53±1.64) ml,and vertebral height recovery was (0.49±0.86)% on average. Ten cases were with vertebral body space fracture,7 cases with bone cement leakage to the intervertebral disc,9 cases with bone cement leakage to the peripheral tissue and 14 cases were treated by systemic anti-osteoporosis treatment after operation. Other 190 cases in non-surgical vertebral body without fracture group,and there were 42 males and 148 females,aged (66.98±7.55) years. Bone mineral density was (-3.13±0.59) SD,fracture compressed degree was (0.39±0.60)%,bone cement injected volume was (4.72±1.28) ml,and vertebral height recovery was (0.46±0.94)% on average. Among them,13 cases were with vertebral body space fracture,5 cases with bone cement leakage to the intervertebral disc,29 cases with bone cement leakage to the peripheral tissue and 129 cases were treated by systemic anti-osteoporosis treatment after operation. The factors of gender,age,fracture compressed degree,fractured type,bone mineral density,bone cement injected volume,bone cement leakage,vertebral height recovery,adjacent vertebral fractures,and systemic anti-osteoporosis treatment were studied in the two groups for single factor analysis. For the results with significant differences among above factors,the multivariate logistic regression analysis was used to research the non-surgical vertebral fracture risk factors.
Results: Among the 219 patients with single thoracolumbar fractures,29 cases occurred non-surgical vertebral fractures. The single factor analysis results showed that there was no significant correlation between non-surgical vertebral fracture occurrecne with age,sex,fracture compressed degree,bone cement injected volume,and vertebral height recovery(P>0.05),but there was a significant correlation between non-surgical vertebral fracture occurrence with fractured type,bone cement leakage,systemic anti-osteoporosis treatment,and bone mineral density (P<0.05). Multivariate logistic regression analysis showed that fractured type(OR=0.135),whether systemic anti-osteoporosis treatment (OR=3.793),bone cement leakage (OR=8.975),and bone density (OR=57.079) are risk factors for postoperative non-surgical vertebral fractures.
Conclusion: Improving the quality of the people,systemic preventing and treating the osteoporosis,improving the surgical skills and decreasing the bone cement leakage during operation are effective methods to prevent postoperative non-surgical vertebral fractures. |
| KEYWORDS:Percutaneous kyphoplasty Spinal fractures Osteoporosis Risk factors |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 吴健,关月红,范胜利.单节段胸腰段骨折经皮后凸成形术后再骨折的风险因素分析[J].中国骨伤,2017,30(9):833~837 |
| 英文格式: | WU Jian,GUAN Yue-hong,FAN Sheng-li.Risk factors of non-surgical vertebral fracture after percutaneous kyphoplasty of single segment thoracolumbar fracture[J].zhongguo gu shang / China J Orthop Trauma ,2017,30(9):833~837 |
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