Analysis of influencing factors of osteoporotic compression fractures of thoracolumbar vertebrae after PVP and recurrent fractures after PKP

doi:10.3877/cma.j.issn.2096-0263.2022.03.003

Abstract

Abstract:

Objective

To investigate the risk factors of recent recurrence of osteoporotic thoracolumbar compression fractures (OVCF) after percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP).

Methods

The clinical data of 562 patients who underwent PVP or PKP for thoracolumbar osteoporotic compression fractures in CITIC Huizhou Hospital from September 2017 to September 2021 were retrospectively analyzed, including 192 males and 370 females with an average age (76±8) years old, divided into recurrent fracture group (n=72) and non-recurrent fracture group (n=490). The patient's gender, age, weight, height, body mass index (BMI), bone mineral density QCT value, kyphosis angle (Cobb), surgical method, previous history of fracture, bone cement injection volume, puncture method, and regular use Variables such as anti-osteoporosis drug treatment and bone cement leakage were included in the risk factor analysis of postoperative recurrent fractures.

Results

562 patients were followed up, the follow-up rate was 95.90%, and the follow-up time was (14±4) months. The incidence of refracture within 1 year was 12.81% (72/562), and the number of refracture within 3 months accounted for 15.28% (11/72) of the total incidence. Univariate analysis showed that age, gender, QCT value, history of fracture, regular use of anti-osteoporosis drugs, and bone cement leakage were associated with refracture after PVP or PKP (P<0.05); multivariate Logistic regression analysis showed that advanced age (OR=1.095, 95% CI: 1.079, 1.111), other history of other fractures (OR=1.311, 95% CI: 1.082, 1.633) and bone cement leakage (OR=1.756, 95% CI: 1.112, 2.797) was the main risk factor for recent refracture after PVP or PKP in patients with thoracolumbar OVCF, and regular use of anti-osteoporosis drugs (OR=0.130, 95% CI: 0.012, 0.347) was the protective factor for recent refracture after surgery (P<0.05).

Conclusion

The main risk factors for re-fracture in patients with thoracolumbar OVCF undergoing PVP or PKP are advanced age, previous history of other fractures, and bone cement leakage. It is recommended that patients take reasonable calcium supplements and take anti-osteoporosis drugs regularly.

Key words: Osteoporotic vertebral compression fracture, Percutaneous vertebroplasty, percutaneous kyphoplasty, Refractures

Wenjun Deng, Shaojin Yu, Jianlong Xie. Analysis of influencing factors of osteoporotic compression fractures of thoracolumbar vertebrae after PVP and recurrent fractures after PKP[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2022, 08(03): 140-146.

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References 20

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变量		再发骨折组（n=72）	未再发骨折组（n=490）	χ²/t/Z值	P值
年龄（岁）				3.319	<0.001
		77.28±8.42	73.15±10.05
性别				6.261	0.012
	男	34（47.22）	158（32.24）
	女	38（52.78）	332（67.76）
BMI（kg/m²）				1.310	0.191
		21.35±2.21	20.83±3.26
术前合并症
	糖尿病	25（34.72）	198（40.41）	0.848	0.357
	高血压	41（56.94）	223（45.51）	3.295	0.070
	冠心病	23（31.94）	168（34.29）	0.153	0.695
骨折分型				0.171	0.864
	Ⅰ级	24（33.33）	157（32.04）
	Ⅱ级	31（43.06）	216（44.08）
	Ⅲ级	17（23.61）	117（23.88）
QCT值（mg/cm³）				1.735	0.083
		58.44±12.13	61.96±16.57
Cobb角（°）				1.238	0.216
		16.98±1.14	17.15±1.08
手术方式				3.664	0.056
	PVP	26（36.11）	236（48.16）
	PKP	46（63.89）	254（51.84）
既往有无骨折病史				17.141	<0.001
	有	49（68.06）	206（42.04）
	无	23（31.94）	284（57.96）
骨水泥注入量（ml）				1.500	0.134
		3.55±0.72	3.73±0.98
穿刺方法				1.093	0.296
	单侧	14（19.44）	72（14.69）
	双侧	58（80.56）	418（85.31）
是否规律使用抗骨质疏松药物治疗				7.502	0.006
	有	15（20.83）	183（37.35）
	无	57（79.17）	307（62.65）
术后并发症
	低血压	8（11.11）	59（12.04）	0.052	0.820
	骨水泥渗漏	18（25.00）	42（8.57）	17.767	<0.001
	骨水泥肺栓塞	4（5.56）	35（7.14）	0.061	0.805

变量		再发骨折组（n=72）	未再发骨折组（n=490）	χ²/t/Z值	P值
年龄（岁）				3.319	<0.001
		77.28±8.42	73.15±10.05
性别				6.261	0.012
	男	34（47.22）	158（32.24）
	女	38（52.78）	332（67.76）
BMI（kg/m²）				1.310	0.191
		21.35±2.21	20.83±3.26
术前合并症
	糖尿病	25（34.72）	198（40.41）	0.848	0.357
	高血压	41（56.94）	223（45.51）	3.295	0.070
	冠心病	23（31.94）	168（34.29）	0.153	0.695
骨折分型				0.171	0.864
	Ⅰ级	24（33.33）	157（32.04）
	Ⅱ级	31（43.06）	216（44.08）
	Ⅲ级	17（23.61）	117（23.88）
QCT值（mg/cm³）				1.735	0.083
		58.44±12.13	61.96±16.57
Cobb角（°）				1.238	0.216
		16.98±1.14	17.15±1.08
手术方式				3.664	0.056
	PVP	26（36.11）	236（48.16）
	PKP	46（63.89）	254（51.84）
既往有无骨折病史				17.141	<0.001
	有	49（68.06）	206（42.04）
	无	23（31.94）	284（57.96）
骨水泥注入量（ml）				1.500	0.134
		3.55±0.72	3.73±0.98
穿刺方法				1.093	0.296
	单侧	14（19.44）	72（14.69）
	双侧	58（80.56）	418（85.31）
是否规律使用抗骨质疏松药物治疗				7.502	0.006
	有	15（20.83）	183（37.35）
	无	57（79.17）	307（62.65）
术后并发症
	低血压	8（11.11）	59（12.04）	0.052	0.820
	骨水泥渗漏	18（25.00）	42（8.57）	17.767	<0.001
	骨水泥肺栓塞	4（5.56）	35（7.14）	0.061	0.805

变量	变量赋值
年龄	实测值
性别	0=男，1=女
QCT值	实测值
既往有无骨折病史	0=是，1=否
是否规律使用抗骨质疏松药物治疗	0=是，1=否
穿刺方法	0=单侧，1=双侧
术前合并症	0=糖尿病，1=高血压，2=冠心病
骨折分级	0=Ⅰ级，1=Ⅱ级，2=Ⅲ级
术后并发症	0=低血压，1=骨水泥渗漏，2=骨水泥肺栓塞

变量	变量赋值
年龄	实测值
性别	0=男，1=女
QCT值	实测值
既往有无骨折病史	0=是，1=否
是否规律使用抗骨质疏松药物治疗	0=是，1=否
穿刺方法	0=单侧，1=双侧
术前合并症	0=糖尿病，1=高血压，2=冠心病
骨折分级	0=Ⅰ级，1=Ⅱ级，2=Ⅲ级
术后并发症	0=低血压，1=骨水泥渗漏，2=骨水泥肺栓塞

影响因素	β	S.E	Wald	OR	95% CI	P值
年龄	0.091	0.007	169.000	1.095	1.079，1.111	<0.001
性别	0.423	0.275	2.366	1.527	0.041，0.445	0.124
QCT值	0.102	0.057	3.202	1.107	0.726，1.538	0.074
既往有无骨折病史	0.271	0.112	5.855	1.311	1.082，1.633	0.016
是否规律使用抗骨质疏松药物治疗	-2.038	0.698	8.525	0.130	0.012，0.347	0.004
骨水泥是否渗漏	0.563	0.236	5.691	1.756	1.112，2.797	0.017
穿刺方法	0.419	0.228	3.377	1.520	1.052，2.188	0.066
骨折分级	0.115	0.062	3.440	1.522	0.186,1.952	0.064

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