骨水泥/椎体体积比与经皮椎体成形术后邻近椎体压缩骨折的相关性分析

doi:10.3760/cma.j.cn441417-20241225-09003

摘要/Abstract

摘要：

　目的　分析骨水泥/椎体体积比与经皮椎体成形术（PVP）后邻近椎体压缩骨折（AVCF）的相关性。方法　回顾性分析陕西省康复医院脊柱外科2018年6月至2022年6月收治的202例行PVP治疗的骨质疏松性椎体压缩骨折患者的临床资料，其中男89例、女113例，年龄56～78（67.98±6.93）岁，术后随访6～12（8.32±2.31）个月。根据术后是否发生AVCF将其分为AVCF组（31例）和无AVCF组（171例）。对两组患者人口特征资料、体重指数、骨密度、骨水泥渗漏、骨水泥体积（BCV）、较大侧骨椎体体积（LSBCV）、椎体体积（VBV）、BCV/VBV、LSBCV/VBV等指标进行单因素和多因素logistic回归分析。绘制受试者操作特征曲线（ROC）分析各影响因素预测PVP术后AVCF的效能。采用独立样本t检验、χ²检验进行统计学分析。结果　术前骨密度T值、LSBCV、LSBCV/VBV、骨水泥渗漏情况对PVP术后AVCF有显著影响（均P<0.05）。多因素logistic回归分析显示，低术前骨密度T值（OR=0.377）、高LSBCV/VBV（OR=2.123）是PVP术后发生AVCF的独立危险因素（均P<0.05）。术前骨密度T值预测PVP术后发生AVCF的曲线下面积（AUC）为0.638（0.559～0.746）；LSBCV/VBV的AUC为0.800（0.723～0.877），最佳诊断阈值为13.859%，此时LSBCV/VBV预测PVP术后发生AVCF的灵敏度、特异度、约登指数、阳性预测值、阴性预测值分别为83.87%、66.67%、0.505、31.33%、95.80%。结论　低术前骨密度T值、高LSBCV/VBV是PVP术后发生AVCF的独立危险因素，LSBCV/VBV对PVP术后AVCF有一定预测价值。

关键词:

经皮椎体成形术, 邻近椎体压缩骨折, 骨水泥/椎体体积比, 相关性, 受试者操作特征曲线

Abstract:

Objective　To analyze the correlation between bone cement/vertebral body volume ratio and adjacent vertebral compression fractures (AVCF) after percutaneous vertebroplasty (PVP). Methods　The clinical data of 202 patients with osteoporotic vertebral compression fracture treated by PVP from June 2018 to June 2022 in the Department of Spinal Surgery of Shaanxi Provincial Rehabilitation Hospital were retrospectively analyzed, including 89 males and 113 females, with an age of 56-78 (67.98±6.93) years old, followed up for 6-12 (8.32±2.31) months. According to whether AVCF occurred after operation, the patients were divided into an AVCF group (31 cases) and a non-AVCF group (171 cases). Univariate and multivariate logistic regression analysis were used to analyze on demographic data, body mass index, bone density, bone cement leakage, bone cement volume (BCV), larger vertebral body volume (LSBCV), vertebral body volume (VBV), BCV/VBV, LSBCV/VBV, and other indicators for two groups. The receiver operator characteristic curve (ROC) was used to analyze the efficacies of influencing factors in predicting AVCF after PVP. Independent sample t test and χ² test were used for statistical analysis. Results　Preoperative bone mineral density T value, LSBCV, LSBCV/VBV, and bone cement leakage had significant effects on AVCF after PVP (all P<0.05). Multivariate logistic regression analysis showed that low preoperative bone mineral density (OR=0.377) and high LSBCV/VBV (OR=2.123) were independent risk factors for AVCF after PVP (both P<0.05). The area under the curve (AUC) of preoperative bone mineral density in predicting the occurrence of AVCF after PVP was 0.638 (0.559-0.746). The AUC of LSBCV/VBV was 0.800 (0.723-0.877), and the optimal diagnostic threshold was 13.859%; the sensitivity, specificity, Youden index, positive predictive value, and negative predictive value of LSBCV/VBV in predicting the occurrence of AVCF after PVP were 83.87%, 66.67%, 0.505, 31.33%, and 95.80%, respectively. Conclusion　Low preoperative bone mineral density T value and high LSBCV/VBV are independent risk factors for AVCF after PVP, and LSBCV/VBV has certain predictive value for AVCF after PVP.

Key words:

Percutaneous vertebroplasty, Adjacent vertebral compression fractures, Bone cement/vertebral body volume ratio, Relevance, Receiver operator characteristic curve

杨月太贾本治.

骨水泥/椎体体积比与经皮椎体成形术后邻近椎体压缩骨折的相关性分析 [J]. 国际医药卫生导报, 2025, 31(9): 1421-1425.

Yang Yuetai, Jia Benzhi.

Correlation analysis between bone cement/vertebral body volume ratio and adjacent vertebral compression fractures after percutaneous vertebroplasty [J]. International Medicine and Health Guidance News, 2025, 31(9): 1421-1425.

参考文献

[1] 张宁,蔡飞,李长红,等.手法复位结合弯角经皮椎体成形术与单纯经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折的效果比较[J].中国医药导报,2021,18(21):79-83. DOI:10.20047/j.issn1673-7210.2021.21.019.
[2] 钟华,周志宏,郭乐斌,等.单侧拐角穿刺和传统直针穿刺椎体成形术治疗骨质疏松性椎体压缩性骨折的临床疗效比较[J].国际医药卫生导报,2023,29(3):348-352. DOI:10.3760/cma.j.issn.1007-1245.2023.03.011.
[3] 张子龙,杨俊松,井齐明,等.椎体成形术与后凸成形术治疗累及椎体中1/3急性骨质疏松性椎体压缩骨折的疗效对比[J].骨科,2022,13(1):34-40. DOI:10.3969/j.issn. 1674-8573.2022.01.009.
[4] 魏绪建,臧丽芳,程晓莉,等.经皮钛网骨水泥填充术治疗老年骨质疏松性椎体压缩性骨折的临床效果[J].国际医药卫生导报,2022,28(5):637-641. DOI:10.3760/cma.j.issn. 1007-1245.2022.05.011.
[5] 胡浩,曹开学,黄攀,等.超高龄骨质疏松性胸腰椎压缩骨折经皮椎体成形术术后邻椎再骨折的危险因素分析[J].中国骨伤,2022,35(8):710-714. DOI:10.12200/j.issn. 1003-0034. 2022.08.002.
[6] 董云鹏,李伟举,胡青松,等.肌少症对经皮椎体成形术治疗骨质疏松性椎体压缩性骨折手术疗效的影响[J].中华骨质疏松和骨矿盐疾病杂志,2023,16(3):230-235. DOI:10.3969/j.issn.1674-2591.2023.03.006.
[7] 王强,张骏,王天,等.经皮椎体成形术治疗骨质疏松性椎体压缩骨折的临床疗效及术后邻近椎体骨折的危险因素分析[J].现代生物医学进展,2021,21(21):4095-4099. DOI:10.13241/j.cnki.pmb.2021.21.020.
[8] 张大鹏,毛克亚,强晓军,等.弯角经皮椎体成形术治疗骨质疏松性椎体压缩性骨折术后的骨水泥分布[J].脊柱外科杂志,2022,20(2):121-124. DOI:10.3969/j.issn.1672-2957. 2022.02.011.
[9] Zhou C, Huang S, Liao Y, et al. Correlation analysis of larger side bone cement volume/vertebral body volume ratio with adjacent vertebral compression fractures during vertebroplasty[J]. Front Endocrinol (Lausanne), 2023, 14:1072087. DOI: 10.3389/fendo.2023.1072087.
[10] 印平,马远征,马迅,等.骨质疏松性椎体压缩性骨折的治疗指南[J].中国骨质疏松杂志,2015,21(6):643-648. DOI:10.3969/j.issn.1006-7108.2015.06.001.
[11] 邱贵兴,裴福兴,胡侦明,等.中国骨质疏松性骨折诊疗指南(全文)(骨质疏松性骨折诊断及治疗原则)[J/CD].中华关节外科杂志(电子版),2015,9(6):795-798. DOI:10.3877/cma.j.issn.1674-134X.2015.06.021.
[12] 谢铁钢.骨质疏松性椎体压缩性骨折的临床特点分析[J].中国伤残医学,2019(A1):577.
[13] 李杨,陈勇,李传,等.经皮椎弓根钉内固定联合PKP手术治疗骨质疏松性椎体压缩骨折的疗效分析[J].颈腰痛杂志,2018,39(4):448-451. DOI:10.3969/j.issn.1005-7234. 2018.04.004.
[14] 杜闫圻,毕郑刚.椎体成形术及椎体后凸成形术治疗骨质疏松性椎体压缩性骨折研究进展[J].安徽医药,2022,26(8):1490-1495. DOI:10.3969/j.issn.1009-6469.2022.08.002.
[15] 林昱,刘文革,王振宇.经皮椎体成形术治疗以脊柱源性腹痛为主要症状的骨质疏松性椎体压缩性骨折[J].中国骨伤,2022,35(5):418-422. DOI:10.12200/j.issn.1003-0034. 2022.05.003.
[16] 王宝虎,邬博来,马智敏,等.单侧与双侧椎弓根入路经皮椎体后凸成形术治疗骨质疏松性椎体侧方压缩性骨折的对比研究[J].中医正骨,2021,33(8):16-22. DOI:10.3969/j.issn.1001-6015.2021.08.004.
[17] Yu W, Liang D, Yao Z, et al. Risk factors for recollapse of the augmented vertebrae after percutaneous vertebroplasty for osteoporotic vertebral fractures with intravertebral vacuum cleft[J]. Medicine (Baltimore), 2017, 96(2):e5675. DOI: 10.1097/MD. 0000000000005675.
[18] 张子龙,井齐明,乔瑞,等.骨质疏松性椎体压缩骨折经皮椎体成形术后邻近椎体新发骨折的危险因素分析[J].中国修复重建外科杂志,2021,35(1):20-25. DOI:10.7507/1002-1892.202008044.
[19] 安忠诚,陈晨,董黎强,等.经皮椎体后凸成形术后邻近节段再骨折的危险因素分析[J].中华全科医学,2022,20(4):591-593,712. DOI:10.16766/j.cnki.issn.1674-4152. 002407.
[20] 谭海涛,王挺锐,钟贞浩,等.骨质疏松性椎体压缩性骨折患者PVP后新发椎体压缩骨折及骨水泥渗漏风险列线图预测模型的构建及应用[J].临床和实验医学杂志,2023,22(14):1511-1515. DOI:10.3969/j.issn.1671-4695. 2023.14.015.
[21] Röder C, Boszczyk B, Perler G, et al. Cement volume is the most important modifiable predictor for pain relief in BKP: results from SWISSspine, a nationwide registry[J]. Eur Spine J, 2013, 22(10):2241-2248. DOI: 10.1007/s00586-013-2869-3.
[22] 黄永恒,刘星,尚显文.骨质疏松性椎体压缩性骨折患者PKP治疗后发生邻近椎体骨折的危险因素分析[J].山东医药,2021,61(23):72-76. DOI:10.3969/j.issn.1002- 266X. 2021.23.018.
[23] Nagaraja S, Awada HK, Dreher ML, et al. Effects of vertebroplasty on endplate subsidence in elderly female spines[J]. J Neurosurg Spine, 2015, 22(3):273-282. DOI: 10.3171/2014.10.SPINE14195.
[24] 于洪波,王鹏,贾军,等.老年骨质疏松性椎体压缩骨折经皮椎体后凸成形术后再骨折的危险因素分析[J].老年医学研究,2022,3(1):5-8. DOI:10.3969/j.issn.2096-9058. 2022.01.002.
[25] Lu K, Liang CL, Hsieh CH, et al. Risk factors of subsequent vertebral compression fractures after vertebroplasty[J]. Pain Med, 2012, 13(3):376-382. DOI: 10.1111/j.1526-4637.2011.01297.x.
[26] 许有银,吴俊贤,王建光.弯角PVP与常规单侧经椎弓根入路PVP治疗胸腰椎骨质疏松性压缩骨折的骨水泥分布及疗效对比[J].川北医学院学报,2022,37(6):750-753,758. DOI:10.3969/j.issn.1005-3697.2022.06.016.
[27] 钟福阳,刘伟,张建光.经皮椎体成形术联合唑来膦酸治疗骨质疏松性椎体压缩骨折的疗效观察[J].中国骨与关节损伤杂志,2021,36(9):949-950. DOI:10.7531/j.issn. 1672-9935.2021.09.017.
[28] 杨利丽,李秋菊,罗丽娟,等.经皮椎体成形术联合抗骨质疏松药物治疗围绝经期女性骨质疏松性椎体压缩骨折的疗效观察[J].中国妇幼保健,2017,32(14):3239-3241. DOI:10.7620/zgfybj.j.issn.1001-4411.2017.14.52.
[29] 欧炳金,钱启恒,农宁,等.经皮椎体成形术治疗老年骨质疏松性椎体压缩骨折骨水泥渗漏的危险因素分析[J].骨科,2023,14(4):327-333. DOI:10.3969/j.issn.1674-8573. 2023.04.006.
[30] 曹冬子,许正伟,王存良,等.老年骨质疏松性椎体压缩骨折经皮椎体后凸成形术后新发骨折的危险因素分析[J].空军医学杂志,2018,34(1):41-44. DOI:10.3969/j.issn.2095- 3402. 2018.01.012.
[31] 谢胜荣,陈冬梅,王艳,等.骨质疏松性胸腰椎压缩骨折双侧穿刺经皮椎体成形术中不同层面穿刺对骨水泥分布与疗效的影响研究[J].中国修复重建外科杂志,2023,37(3):329-335.
[32] 郭川,刘枫.PVP后骨水泥分布类型对老年骨质疏松骨折患者恢复情况及再骨折发生的影响分析[J].新疆医学,2021,51(12):1379-1381.