急性症状性胸腰椎骨质疏松性压缩骨折椎体强化术后伤椎再骨折的危险因素分析

Objective To investigate the risk factors of refracture of the injured vertebrae after percutaneous vertebral augmentation for acute symptomatic thoracolumbar osteoporotic compression fractures (ASTOCFs). Methods A case⁃control study was conducted to analyze the clinical data of 2 237 ASTOCFs patients admitted to three hospitals from January 2010 to January 2019. There were 569 males and 1 668 females, with age range of 50⁃85 years [(66. 7±4. 8)years]. The patients underwent percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP). According to the radiographic outcomes, the patients were divided into refracture group (n=315) and non⁃refracture group (n=1 922). Data were recorded for the two groups, including basic demographics (gender, age, height and weight), personal habits (smoking and alcohol consumption), basic diseases (diabetes, hypertension, coronary heart disease and chronic obstructive pulmonary disease), preoperative bone mineral density, fracture segment, number of injured vertebrae, surgical method (PVP or PKP), surgical approach, bone cement viscosity, distance from cement to the upper and lower endplate, cement volume in injured vertebrae, cement leakage, postoperative exercise, and postoperative anti⁃osteoporosis treatment. The above data were analyzed to identify their correlation with postoperative refracture of the injured vertebrae by univariate analysis. The independent risk factors for postoperative refracture of the injured vertebrae were determined by multivariate Logistic regression analysis. Results Univariate analysis showed that refracture of injured vertebrae was correlated with gender, age, diabetes, fracture segment, surgical method, distance from cement to the upper and lower endplate, postoperative exercise, and postoperative anti⁃osteoporosis treatment (P<0. 05 or 0. 01), but there was no correlation with height, weight, smoking, alcohol consumption, hypertension, coronary heart disease, chronic obstructive pulmonary disease, preoperative bone mineral density, number of fractured vertebrae, surgical approach, bone cement viscosity, cement volume in injured vertebrae or cement leakage (all P>0. 05). Multivariate Logistic regression analysis showed that female (OR=1. 92, 95%CI 1. 34-2. 64, P<0. 01), age ≥ 80 years (OR=1. 21, 95%CI 1. 17-1. 25, P<0. 01), diabetes (OR=1. 92, 95%CI 0. 44-2. 55, P<0. 01), thoracolumbar fracture (OR=1. 46, 95%CI 1. 82-7. 51, P<0. 05), PKP (OR=4. 56, 95%CI 0. 86-1. 44, P< 0. 05), no postoperative exercise (OR=2. 14, 95%CI 0. 27-0. 38, P<0. 01), and no postoperative anti⁃osteoporosis treatment (OR=2. 36,95%CI 0. 13-0. 47, P<0. 05) were positively correlated with refracture of injured vertebrae. Conclusion Female, age ≥80 years, diabetes, thoracolumbar fracture, PKP, no postoperative exercise, and no postoperative anti⁃osteoporosis treatment are independent risk factors for refracture of injured vertebrae after percutaneous vertebral augmentation for ASTOCFs.