Chen Zhi, Yao Zhipeng, Wu Chengjian, Wang Guohua, Liu Wenge
Department of Orthopedics Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China.
Department of Orthopedics Surgery, Fuqing Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, Fujian, China.
Skeletal Radiol. 2022 Aug;51(8):1623-1630. doi: 10.1007/s00256-022-04009-5. Epub 2022 Feb 5.
Currently, the risk factors for subsequent fracture following vertebral augmentation remain incomplete and controversial. To provide clinicians with accurate information for developing a preventive strategy, we carried out a comprehensive evaluation of previously controversial and unexplored risk factors.
We retrospectively reviewed patients with osteoporotic vertebral compression fracture in lumbar spine who received vertebral augmentation between January 2019 and December 2020. Based on whether refracture occurred, patients were assigned to refracture and non-refracture group. The clinical characteristics, imaging parameters (severity of vertebral compression, spinal sagittal alignment, degeneration of paraspinal muscles), and surgical indicators (cement distribution and leakage, correction of spinal sagittal alignment) were collected and analyzed.
There were 128 patients and 16 patients in non-refracture and refracture group. The incidence of previous fracture, multiple fractures, and cement leakage were notably higher, relative cross-sectional area of psoas (r-CSA) was significantly smaller, CSA ratio, fatty infiltration of erector spinae plus multifidus (FI), FI, postoperative lumbar lordosis (post-LL), correction of body angel (BA), and LL were significantly greater in refracture group. Binary logistic regression analysis revealed previous fracture, cement leakage, post-LL, and correction of BA were independent risk factors. According to the ROC curve, correction of BA showed the highest prediction accuracy, and the critical value was 3.45°.
The occurrence of subsequent fracture might be the consequence of multiple factors. Previous fracture, cement leakage, post-LL, and correction of BA were identified as independent risk factors. Furthermore, the correction of BA should not exceed 3.45°, especially in patients with risk factors.
目前，椎体强化术后继发骨折的危险因素仍不完整且存在争议。为给临床医生制定预防策略提供准确信息，我们对先前有争议及未探索的危险因素进行了全面评估。
我们回顾性分析了2019年1月至2020年12月期间因腰椎骨质疏松性椎体压缩骨折接受椎体强化治疗的患者。根据是否发生再骨折，将患者分为再骨折组和非再骨折组。收集并分析临床特征、影像参数（椎体压缩程度、脊柱矢状面排列、椎旁肌退变情况）及手术指标（骨水泥分布及渗漏、脊柱矢状面排列的矫正情况）。
非再骨折组和再骨折组分别有128例和16例患者。再骨折组既往骨折、多发骨折及骨水泥渗漏的发生率显著更高，腰大肌相对横截面积（r-CSA）显著更小，竖脊肌加多裂肌的CSA比值、脂肪浸润（FI）、FI、术后腰椎前凸（post-LL）、椎体角度（BA）矫正及LL显著更大。二元逻辑回归分析显示既往骨折、骨水泥渗漏、post-LL及BA矫正为独立危险因素。根据ROC曲线，BA矫正的预测准确性最高，临界值为3.45°。
继发骨折的发生可能是多种因素共同作用的结果。既往骨折、骨水泥渗漏、post-LL及BA矫正被确定为独立危险因素。此外，BA矫正不应超过3.45°，尤其是对于有危险因素的患者。
