Matsumoto Koji, Hoshino Masahiro, Omori Keita, Igarashi Hidetoshi, Matsuzaki Hiromi, Tokuhashi Yasuaki
Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, 30-1 Oyaguchikamimati, Itabashi-ku, Tokyo, 173-8610, Japan.
Department of Orthopaedic Surgery, Sonoda Medical Institute Tokyo Spine Center, 2-5-10 Ikohoncyo Adati-ku, Tokyo, 121-0807, Japan.
J Orthop Sci. 2021 Jul;26(4):538-542. doi: 10.1016/j.jos.2020.06.003. Epub 2020 Jul 22.
Adjacent vertebral fracture (AVF) is a major complication following Balloon Kyphoplasty (BKP). There is no scoring system for predicting AVF using only preoperative elements. The purposes of this study were to develop a scoring system for predicting early AVF after BKP based on preoperative factors and to investigate the appropriate surgical indication for BKP.
Of 220 patients who underwent BKP at a single institution since 2011, 65 patients over the age of 60 who had undergone a standing whole spine X-ray preoperatively were enrolled. Factors affecting the occurrence of early AVF were examined. A scoring system was created consisting of the factors exhibiting significant differences, and the correlation between the total score and the incidence of early AVF was investigated.
Twenty of the 65 patients (30.8%) had early AVF. In a univariate analysis, age, previous vertebral fracture, pelvic tilt, and Local kyphosis significantly influenced early AVF. In a multivariate logistic regression analysis, age had an odds ratio of 1.136 (95% CI 1.001-1.289), previous vertebral fractures 4.181 (1.01-17.309), and Local kyphosis 1.103 (1.021-1.191). The scoring system was set as follows: ①Age (<75 years: 0 points(P), 75years≦: 1P), ②The number of previous vertebral fractures (0: 0 P, 1: 1P, 2: 2P, 3 or more: 3P), and ③Local kyphosis (<10°: 0P, 10°≦: 1P). There was a correlation between the total score and the incidence of early AVF (r = 0.812, ∗P = 0.05). The incidence of early AVF was 6.4% (2 cases/31 cases) for a score of ≦1P and 54.5% (18 cases/33 cases) for a score of ≧2P.
There was a correlation between the total score and the incidence of early AVF. A score of 1 point or less may represent the appropriate surgical indication for BKP.
邻椎骨折（AVF）是球囊椎体后凸成形术（BKP）后的主要并发症。目前尚无仅使用术前因素预测AVF的评分系统。本研究的目的是基于术前因素开发一种预测BKP术后早期AVF的评分系统，并探讨BKP合适的手术指征。
自2011年以来，在单一机构接受BKP的220例患者中，纳入65例年龄≥60岁且术前进行了站立位全脊柱X线检查的患者。研究影响早期AVF发生的因素。由显示出显著差异的因素创建评分系统，并研究总分与早期AVF发生率之间的相关性。
65例患者中有20例（30.8%）发生早期AVF。单因素分析中，年龄、既往椎体骨折、骨盆倾斜度和局部后凸对早期AVF有显著影响。多因素logistic回归分析中，年龄的比值比为1.136（95%CI 1.001-1.289），既往椎体骨折为4.181（1.01-17.309），局部后凸为1.103（1.021-1.191）。评分系统设定如下：①年龄（<75岁：0分，75岁及以上：1分），②既往椎体骨折数量（0次：0分，1次：1分，2次：2分，3次及以上：3分），③局部后凸（<10°：0分，10°及以上：1分）。总分与早期AVF发生率之间存在相关性（r = 0.812，*P = 0.05）。评分≤1分的早期AVF发生率为6.4%（2例/31例），评分≥2分的为54.5%（18例/33例）。
总分与早期AVF发生率之间存在相关性。1分及以下的评分可能代表BKP合适的手术指征。
