Zhang Zilong, Jing Qiming, Qiao Rui, Yang Jiarui, Chen Haojie, Qian Lixiong, Zhang Xuefang, Yang Junsong, Hao Dingjun
Xi'an Medical College, Xi'an Shaanxi, 710045, P.R.China.
Department of Spine Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021 Jan 15;35(1):20-25. doi: 10.7507/1002-1892.202008044.
To investigate the risk factors of adjacent fractures after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (OVCF).
A total of 2 216 patients who received PVP due to symptomatic OVCF between January 2014 and January 2017 and met the selection criteria were selected as study subjects. The clinical data was collected, including gender, age, height, body mass, history of smoking and drinking, whether the combination of hypertension, diabetes, coronary arteriosclerosis, chronic obstructive pulmonary disease (COPD), bone mineral density, the number of fractured vertebrae, the amount of cement injected into single vertebra, the cement leakage, and whether regular exercise after operation, whether regular anti-osteoporosis treatment after operation. Firstly, single factor analysis was performed on the observed indicators to preliminarily screen the influencing factors of adjacent fractures after PVP. Then, logistic regression analysis was carried out for relevant indicators with statistical significance to screen risk factors.
All patients were followed up 12-24 months, with an average of 15.8 months. Among them, 227 patients (10.24%) had adjacent fractures. The univariate analysis showed that there were significant differences between the fracture group and non-fracture group in age, gender, preoperative bone density, history of smoking and drinking, COPD, the number of fractured vertebrae and the amount of bone cement injected into the single vertebra, as well as regular exercise after operation, regular anti-osteoporosis treatment after operation ( <0.05). Further multivariate logistic regression analysis showed that the elderly and female, history of smoking, irregular exercise after operation, irregular anti-osteoporosis treatment after operation, low preoperative bone density, large number of fractured vertebrae, and small amount of bone cement injected into the single vertebra were risk factors for adjacent fractures after PVP in OVCF patients ( <0.05).
The risk of adjacent fractures after PVP increases in elderly, female patients with low preoperative bone mineral density, large number of fractured vertebrae, and insufficient bone cement injection. The patients need to quit smoking, regular exercise, and anti-osteoporosis treatment after PVP.
探讨经皮椎体成形术（PVP）治疗骨质疏松性椎体压缩骨折（OVCF）后相邻椎体骨折的危险因素。
选取2014年1月至2017年1月因症状性OVCF接受PVP且符合入选标准的2216例患者作为研究对象。收集临床资料，包括性别、年龄、身高、体重、吸烟饮酒史、是否合并高血压、糖尿病、冠状动脉粥样硬化、慢性阻塞性肺疾病（COPD）、骨密度、骨折椎体数量、单椎体注入骨水泥量、骨水泥渗漏情况，以及术后是否规律运动、术后是否规律抗骨质疏松治疗。首先对观察指标进行单因素分析，初步筛选PVP后相邻椎体骨折的影响因素。然后对具有统计学意义的相关指标进行logistic回归分析，筛选危险因素。
所有患者随访12 - 24个月，平均15.8个月。其中，227例患者（10.24%）发生相邻椎体骨折。单因素分析显示，骨折组与非骨折组在年龄、性别、术前骨密度、吸烟饮酒史、COPD、骨折椎体数量、单椎体注入骨水泥量，以及术后规律运动、术后规律抗骨质疏松治疗方面存在显著差异（<0.05）。进一步多因素logistic回归分析显示，老年、女性、吸烟史、术后运动不规律、术后抗骨质疏松治疗不规律、术前骨密度低、骨折椎体数量多、单椎体注入骨水泥量少是OVCF患者PVP后相邻椎体骨折的危险因素（<0.05）。
PVP后相邻椎体骨折风险在术前骨密度低、骨折椎体数量多、骨水泥注入不足的老年女性患者中增加。患者术后需要戒烟、规律运动并进行抗骨质疏松治疗。
