目的:评价经皮椎体成形术(PVP)后发生骨质疏松性椎体压缩骨折(OVCFs)的危险因素。
方法:从2016年1月至2019年11月,回顾性分析患有OVCF的患者。评估了PVP后新OVCF的独立影响因素,来自以下变量:年龄,性别,BMI,BMD,酗酒史,吸烟,高血压,糖尿病,糖皮质激素的使用,和先前的椎骨骨折,初始骨折的数量,平均水泥体积,穿刺方法,D型水泥渗漏及常规抗骨质疏松治疗。
结果:总共268名347级患者符合纳入标准,最终纳入本研究。在随访期间,在33例患者中观察到49例新的OVCFs(12.31%)。它表明女性(调整后OR:6.812,95CI:[1.096,42.337],P=0.040),较低的骨密度(调整后OR:0.477,95CI:[0.300,0.759],P=0.002),先前的椎骨骨折(调整后OR:16.145,95CI:[5.319,49.005],P=0.000),和常规抗骨质疏松治疗(调整后的OR:0.258,95CI:[0.086,0.774],P=0.016)是新OVCF的独立影响因素。BMD达到新OVCF的临界值为-3.350,灵敏度为0.660,特异性为0.848。
结论:女性,较低的BMD(腰椎T评分),既往椎体骨折和常规抗骨质疏松治疗是独立影响因素.BMD(腰椎T评分)低于-3.350会增加新OVCF的风险,没有骨质疏松治疗对PVP术后新发骨折有不利影响。
OBJECTIVE: To evaluate the risk factors of new osteoporotic vertebral compression fractures (OVCFs) after percutaneous vertebroplasty (PVP).
METHODS: From January 2016 to November 2019, patients suffering from OVCFs were retrospectively reviewed. The independent influence factors for new OVCFs after PVP were assessed, from following variables: age, sex, body mass index, bone mineral density (BMD), history of alcoholism, smoking, hypertension, diabetes, glucocorticoid use, and prior vertebral fractures, the number of initial fractures, mean cement volume, method of puncture, D-type of cement leakage, and regular antiosteoporosis treatment.
RESULTS: A total of 268 patients with 347 levels met the inclusion criteria and were finally included in this study. Forty-nine levels of new OVCFs among 33 patients (12.31%) were observed during the follow-up period. It indicated that female (adjusted odds ratio [OR]: 6.812, 95% confidence interval {CI}: [1.096, 42.337], P = 0.040), lower BMD (adjusted OR: 0.477, 95% CI: [0.300, 0.759], P = 0.002), prior vertebral fractures (adjusted OR: 16.145, 95% CI: [5.319, 49.005], P = 0.000), and regular antiosteoporosis treatment (adjusted OR: 0.258, 95% CI: [0.086, 0.774], P = 0.016) were independent influence factors for new OVCF. The cut-off value of BMD to reach new OVCF was -3.350, with a sensitivity of 0.660 and a specificity of 0.848.
CONCLUSIONS: Female, lower BMD (T-score of lumbar), prior vertebral fractures, and regular antiosteoporosis treatment were independent influencing factors. BMD (T-score of lumbar) lower than -3.350 would increase risk for new OVCF, and none osteoporotic treatment has detrimental effect on new onset fractures following PVP.