经皮椎体成形术后椎体再骨折生存率及危险因素分析

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摘要目的确定椎体成形术后新发椎体骨折的自然病程，并分析危险因素，探究相邻椎体骨折(adjacent vertebral fracture，AVF)和远端椎体骨折(remote vertebral fracture，RVF)的发生率及其相关性。方法回顾分析马鞍山市人民医院2018年1月至2021年1月260例接受经皮椎体成形术患者的临床资料，男75例，女185例；年龄62~81岁，平均(67.34±7.21)岁。根据术后至少2年的随访期内有无椎体骨折，将患者分为骨折组和对照组，然后按照骨折椎体与手术椎体的位置关系，将骨折组分为AVF组和RVF组，通过生存分析和各危险因素回归分析，探究AVF和RVF之间发生时间、危险因素是否存在差异。结果 260例患者中新发椎体骨折55例，42例发生相邻椎体骨折，发病时间为(6.2±2.4)个月；13例发生远端骨折，发病时间为(12.3±1.6)个月。在单因素及多因素Cox回归分析中，CT值、抗骨质疏松药物的治疗、矢状面的失衡为AVF的危险因素(P＜0.05)；CT值为RVF的危险因素(P＜0.05)。结论患者在椎体成形术后，邻近椎体骨折的发生时间明显早于远端椎体骨折，CT值、抗骨质疏松药物的治疗、矢状面的失衡是AVF发生的独立危险因素，AVF和RVF发生的公共危险因素是CT值的大小。

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	轩冲
	汪红亮
	周涛

关键词 ：椎体压缩性骨折, 经皮椎体成形术, 新发椎体骨折, 危险因素

Abstract：Objective To determine the natural course of new vertebral fractures after vertebroplasty，analyze the associated risk factors，and investigate the incidence and correlation between adjacent vertebral fracture (AVF) and remote vertebral fracture (RVF).Methods A retrospective analysis was conducted on the clinical data of 260 patients who underwent percutaneous vertebroplasty augmentation surgery in Ma'anshan People’s Hospital from January 2018 to January 2021.75 patients were male and 185 patients were female，with an age range of 62~81 years and a mean age of (67.34±7.21)years.Patients were divided into fracture group and control groups based on the presence or absence of vertebral fractures during a follow-up period of at least 2 years post surgery.The fracture group was further divided into AVF and RVF groups，based on the relationship between the fractured vertebrae and the operated vertebrae.Survival analysis and regression analysis of various risk factors were employed to examine potential differences in occurrence time and risk factors between AVF and RVF.Results Among the 260 patients included in the study，a total of 55 patients presented with newly developed vertebral fractures.42 patients involved adjacent vertebrae，and the average time of onset was (6.2±2.4)months.Furthermore，there were 13 cases of distant fractures，with an average onset time of (12.3±1.6)months.Both singlefactor and multi factor Cox regression analyses were conducted to identify risk factors for AVF and RVF.The results revealed that CT value，treatment with anti osteoporosis drugs，and sagittal imbalance were significant risk factors for AVF (P＜0.05).Additionally，CT value was identified as a risk factor for RVF (P＜0.05).Conclusion The occurrence of AVF is significantly earlier than that of RVF in patients after percutaneous vertebroplasty.The independent risk factors for AVF include CT values，treatment with anti osteoporotic drugs and sagittal plane imbalance.CT values also serve as a common risk factor for both AVF and RVF.

Key words： vertebral compression fractures percutaneous vertebroplasty new vertebral compression fractures risk factors

基金资助:安徽省重点研究与开发计划项目(202104j07020060)

通讯作者: 周涛

作者简介: 轩冲(1998－ )，男，医师，安徽医科大学马鞍山临床学院，944372143@qq.com

引用本文:

轩冲，汪红亮，周涛. 经皮椎体成形术后椎体再骨折生存率及危险因素分析[J]. 实用骨科杂志, 2023, 29(11): 966-.
Xuan Chong，Wang Hongliang，Zhou Tao. Analysis of the Survival Rate and Risk Factors of Vertebral Body Refracture After Percutaneous Vertebroplasty. sygkzz, 2023, 29(11): 966-.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2023/V29/I11/966

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