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目的探讨经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩骨折术后相邻椎体新发骨折的危险因素。方法纳入自2011-08—2014-08诊治的110例骨质疏松性椎体压缩骨折,按照首次PVP术后是否再次发生相邻椎体骨折将患者分为2组,其中观察组25例(术后出现相邻椎体新发骨折),对照组85例。确定年龄、体重指数、骨密度、骨水泥注入量、术后椎体高度矫正百分比、有无骨水泥椎间盘内渗漏、术前有无椎体内裂隙征、术后椎体前缘压缩角度矫正度数、后凸角度矫正度数这9个指标为PVP术后相邻椎体再骨折的相关因素。结果 110例获得随访2~3年,平均2.5年。110例中术后相邻椎体新发骨折25例,发生率为22.7%。单因素分析结果显示,观察组与对照组骨密度、骨水泥椎间盘内渗漏、术前椎体内裂隙征方面差异有统计学意义(P<0.05)。进一步多因素Logistic回归分析显示低骨密度是PVP术后相邻椎体新发骨折的独立危险因素。结论 PVP术后相邻椎体新发骨折的危险因素是骨质疏松,因此PVP术后应该正规抗骨质疏松治疗,防止继发骨折的出现。
Objective To investigate the risk factors of new fractures of adjacent vertebral body after percutaneous vertebroplasty (PVP) for the treatment of osteoporotic vertebral compression fractures. Methods One hundred and ten patients with osteoporotic vertebral compression fractures diagnosed and treated from August 2011 to August 2014 were enrolled in this study. The patients were divided into two groups according to whether the adjacent vertebral fractures occurred again after the first PVP. Among them, 25 cases in the observation group After the adjacent vertebral body fractures), the control group of 85 cases. Determine the age, body mass index, bone mineral density, bone cement injection, the percentage of postoperative vertebral height correction, intramedullary disc leakage, preoperative intra-vertebral fissure sign, postoperative anterior vertebral compression angle correction Degree, kyphosis degree of correction of these 9 indicators for the adjacent vertebral fractures after PVP related factors. Results 110 cases were followed up for 2 to 3 years, an average of 2.5 years. In 110 cases, 25 cases of new fractures of adjacent vertebral body, the incidence was 22.7%. Univariate analysis showed that there was significant difference between the observation group and the control group in bone mineral density, bone cement leakage in the intervertebral disc, and preoperative vertebral body fissure sign (P <0.05). Further multivariate Logistic regression analysis showed that low BMD was an independent risk factor for new fractures of adjacent vertebral body after PVP. Conclusions The risk factors for new fractures of adjacent vertebral bodies after PVP are osteoporosis. Therefore, the treatment of PVP should be formally anti-osteoporosis treatment to prevent the occurrence of secondary fractures.