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目的:探讨经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松压缩骨折(osteoporosis vertebral compression fracture,OVCF)术后新发椎体骨折的危险因素。方法:回顾性分析2011年7月至2013年7月我科采用PKP治疗的86例OVCF患者,根据是否有非手术椎体新发骨折分为新发骨折组(A组)及未骨折组(B组)。采用t检验、方差分析、logistic回归分析新发椎体骨折的危险因素:年龄、性别、骨密度(bone mineral density,BMD)、骨水泥注入量、骨折椎体压缩程度、骨水泥椎间盘漏、骨折椎体数量。结果:21例患者(24.4%)新发骨折,15例发生在术后3个月内,6例发生在3个月后,16例为邻近椎体骨折,5例为非邻近椎体骨折;A组BMD(-3.43±0.42)低于B组(-2.91±0.20)(P=0.000);A组骨水泥椎间盘漏发生率大于B组(P=0.031);A组术前多椎体骨折发生率(≥2个)大于B组(P=0.000)。2组患者的年龄(P=0.453)、性别(P=0.841)、骨水泥注入量(P=0.081)、骨折椎体压缩程度无差别(P=0.717)。logistic回归分析结果:骨密度OR=36 277.255、95%CI=60.057~21 913 095.13、P=0.001,术前存在2个及2个以上椎体骨折OR=13.275、95%CI=1.746~100.938、P=0.012,术中骨水泥发生椎间盘漏OR=26.785、95%CI=1.355~529.551、P=0.031。结论:骨密度低、术前存在2个及2个以上椎体骨折、术中骨水泥发生椎间盘漏是PKP术后新发椎体骨折的危险因素。
Objective: To investigate the risk factors of new vertebral fractures after percutaneous kyphoplasty (PKP) treatment of osteoporosis vertebral compression fracture (OVCF). Methods: A retrospective analysis of 86 cases of OVCF treated with PKP from July 2011 to July 2013 in our department was divided into new fracture group (group A) and non-fracture group Group B). T-test, ANOVA and logistic regression analysis were used to analyze the risk factors of new vertebral fractures: age, sex, bone mineral density (BMD), bone cement injection, degree of vertebral compression fracture, bone cement leakage, fracture The number of vertebrae. RESULTS: Twenty-one patients (24.4%) had new fractures, 15 patients within 3 months after surgery, 6 patients after 3 months, 16 adjacent vertebral fractures and 5 non-adjacent vertebral fractures. In group A, the BMD was lower (-3.43 ± 0.42) than that in group B (-2.91 ± 0.20) (P = 0.000); the incidence of disc leakage in group A was more than that in group B (P = 0.031) The incidence (≥2) was greater than that in the B group (P = 0.000). There were no differences in age (P = 0.453), gender (P = 0.841), bone cement infiltration (P = 0.081) and vertebral compression in the two groups (P = 0.717). Logistic regression analysis showed that OR = 36 277.255, 95% CI = 60.057 ~ 21 913 095.13, P = 0.001. There were 2 or more vertebral fractures before operation, OR = 13.275, 95% CI = 1.746 ~ 100.938, P = 0.012, the incidence of intraoperative bone cement leakage OR = 26.785,95% CI = 1.355 ~ 529.551, P = 0.031. CONCLUSION: Low BMD, with 2 or more vertebral fractures preoperatively, and intraoperative osteoinductive disc leakage are the risk factors for new vertebral fractures after PKP.