椎体成形术治疗老年椎体压缩性骨折疗效的影响因素分析

徐飞; 窦强兵; 李行星; 郑权; 王启伟; 孙良业

doi:10.16766/j.cnki.issn.1674-4152.003232

椎体成形术治疗老年椎体压缩性骨折疗效的影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.003232

徐飞^{1, 2},
窦强兵²,
李行星²,
郑权²,
王启伟²,
孙良业^2, ,

1.
蚌埠医学院研究生院，安徽蚌埠 233000
2.
六安市人民医院骨科，安徽六安 237000

基金项目:

国家自然科学基金项目 82102629

安徽省卫生健康科研项目 AHWJ2022c043

详细信息

通讯作者:
孙良业，E-mail：13605645068@139.com

中图分类号: R683.2 R687.42
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- PDF下载量: 26
- 被引次数: 0
出版历程
- 收稿日期: 2023-06-09
- 网络出版日期: 2024-01-13

Analysis of influencing factors of vertebroplasty in the treatment of senile vertebral compression fracture

1.
Graduate School of Bengbu Medical College, Bengbu, Anhui 233000, China

摘要

摘要: 目的分析影响椎体成形术治疗老年椎体压缩性骨折疗效的相关因素，以期预估患者术后疗效，必要时提前干预以提高治疗有效率。方法回顾性纳入2015年1月—2022年6月在六安市人民医院骨科住院并接受椎体成形术治疗的老年椎体压缩性骨折患者307例。根据日本矫形外科协会评分(JOA评分)改善率将患者分为有效组(257例)和无效组(50例)。从性别、年龄、手术方式、血清Mg²⁺浓度、骨水泥累及上下终板、骨水泥形态、骨水泥部位、骨水泥覆盖骨折线和水肿区、骨质疏松、陈旧性骨折进行归纳分析。使用多因素非条件logistic回归分析研究影响疗效的相关因素。结果 2组骨水泥未累及上下终板、骨水泥为“O”型、骨水泥分布于椎体后2/3位置、骨水泥未覆盖骨折线和水肿区、骨质疏松例数比较差异有统计学意义(均P<0.05)，而2组性别、年龄、血清Mg²⁺浓度是否降低、是否为陈旧性骨折差异无统计学意义(均P>0.05)，且骨水泥未累及上下终板(OR=9.188，P=0.034)、骨水泥为“O”型(OR=29.274，P<0.001)、骨水泥分布于椎体后2/3位置(OR=24.928，P=0.001)、骨水泥未覆盖骨折线和水肿区(OR=16.357，P=0.045)为影响其疗效的独立危险因素。结论骨水泥未累及上下终板、骨水泥为“O”型、骨水泥分布于椎体后2/3位置、骨水泥未覆盖骨折线和水肿区均为影响疗效的独立危险因素。
- 椎体成形术 /
- 椎体压缩性骨折 /
- 骨水泥 /
- 疗效
Abstract: Objective To analyze the factors affecting the effect of vertebroplasty on senile vertebral compression fracture, in order to estimate the postoperative efficacy of patients and intervene in advance if necessary to improve the effectiveness of treatment. Methods A retrospective study was conducted on 307 elderly patients with vertebral compression fracture who were admitted to the Department of Orthopedics of Lu' an People' s Hospital from January 2015 to June 2022 and received vertebroplasty. Patients were divided into effective group (n=257) and ineffective group (n=50) according to the improvement rate of the Japanese Orthopaedic Association score (JOA score). Gender, age, surgical methods, serum Mg²⁺ concentration, bone cement touch the upper and lower endplates, shape of bone cement, part of bone cement, bone cement covering fracture line and edema area, osteoporosis, and old fracture were summarized and analyzed. Multivariate logistic regression was used to analyze the related factors affecting the curative effect. Results There was a positive correlation between cement not involving the upper and lower endplates, cement being "O" shaped, cement being distributed in the posterior 2/3 of the vertebral body, cement not covering the fracture line and oedema area, and osteoporosis and poor efficacy of vertebral compression fractures treated with vertebroplasty, and the differences were statistically significant (all P<0.05). There were no significant differences of gender, age, decrease in serum Mg²⁺ concentration, old fracture or not (all P>0.05). Cement not involving the upper and lower endplates (OR=9.188, P=0.034), cement being "O" shaped (OR=29.274, P<0.001), cement being distributed in the posterior 2/3 of the vertebral body (OR=24.928, P=0.001), and cement not covering the fracture line and oedema area (OR=16.357, P=0.045) were independent risk factors affecting their efficacy. Conclusion Bone cement don' t touch the upper and lower endplates, "O" type of bone cement, distribution of bone cement in the posterior 2/3 of the centrum, and the failure of bone cement to cover the fracture line and edema area are independent risk factors for therapeutic effect.
- Vertebroplasty /
- Vertebral compression fracture /
- Bone cement /
- Curative effect

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图 1 椎体成形术后X线片

注: A示骨水泥累及上下终板；B示骨水泥仅累及上终板；C示骨水泥仅累及下终板；D示骨水泥不累及上下终板；E示骨水泥分布呈“H”型；F示骨水泥分布呈“O”型；G示骨水泥主要分布在椎体前2/3；H示骨水泥主要分布在椎体后2/3。

Figure 1. X-ray after vertebroplasty

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表 1 2组老年VCF患者一般资料比较

Table 1. Comparison of general data between two groups of elderly patients with VCF

项目	有效组 (n=257)	无效组 (n=50)	统计量	P值
性别[例(%)]			0.293^a	0.588
男性	55(85.94)	9(14.06)
女性	202(83.13)	41(16.87)
年龄[M(P₂₅, P₇₅), 岁]	71.00(67.00, 77.00)	71.00(67.00, 75.25)	-0.310^b	0.756
手术方式[例(%)]			0.055^a	0.814
PKP	83(83.00)	17(17.00)
PVP	174(84.06)	33(15.94)
血清Mg²⁺浓度降低[例(%)]			2.574^a	0.109
是	34(75.56)	11(24.44)
否	223(85.11)	39(14.89)
骨水泥累及上下终板[例(%)]			211.630^a	<0.001
是	251(96.91)	8(3.09)
否	6(12.50)	42(87.50)
骨水泥形态[例(%)]			216.946^a	<0.001
“H”型	248(98.41)	4(1.59)
“O”型	9(16.36)	46(83.64)
骨水泥部位[例(%)]			204.273^a	<0.001
前2/3	247(97.63)	6(2.37)
后2/3	10(18.52)	44(81.48)
骨水泥覆盖骨折线和水肿区[例(%)]			171.074^a	<0.001
是	252(94.38)	15(5.62)
否	5(12.50)	35(87.50)
骨质疏松[例(%)]			7.720^a	0.005
是	221(86.33)	35(13.67)
否	36(70.59)	15(29.41)
陈旧性骨折[例(%)]			2.878^a	0.090
是	37(75.51)	12(24.49)
否	220(85.27)	38(14.73)
注: ^a为χ²值，^b为Z值。

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表 2 老年VCF患者疗效影响因素的logistic多元回归分析

Table 2. Logistic multiple regression analysis of influencing factors in elderly patients with VCF

变量	B	SE	Wald χ²	P值	OR值	95% CI
骨水泥累及上下终板	2.218	1.046	4.500	0.034	9.188	1.184~71.327
骨水泥形态	3.377	0.958	12.420	＜0.001	29.274	4.476~191.460
骨水泥部位	3.216	0.945	11.592	0.001	24.928	3.914~158.755
骨水泥覆盖水肿区和骨折线	2.795	1.391	4.034	0.045	16.357	1.070~250.090

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参考文献(21)

[1]	KUTSAL F Y, ERGINERGANI G O. Vertebral compression fractures: still an unpredictable aspect of osteoporosis[J]. Turk J Med Sci, 2021, 51(2): 393-399. doi: 10.3906/sag-2005-315
[2]	WANG L, YU W, YIN X, et al. Prevalence of osteoporosis and fracture in china: the china osteoporosis prevalence study[J]. JAMA Netw Open, 2021, 4(8): e2121106. DOI: 10.1001/jamanetworkopen.2021.21106.
[3]	姚俊鹏, 王建国, 樊子健, 等. 双能CT物质分解成像在椎体压缩性骨折骨髓水肿诊断中的应用价值[J]. 临床放射学杂志, 2021, 40(5): 979-982. YAO J P, WANG J G, FAN Z J, et al. The value of dual-energy CT material decomposition imaging in the diagnosis of bone marrow edema in vertebral compression fractures[J]. Journal of Clinical Radiology, 2021, 40(5): 979-982.
[4]	FUJIMORI T, MIWA T, ODA T. Responsiveness of the Japanese orthopaedic association back pain evaluation questionnaire in lumbar surgery and its threshold for indicating clinically important differences[J]. Spine J, 2019, 19(1): 95-103. doi: 10.1016/j.spinee.2018.05.013
[5]	JINDAL V, BINYALA S, KOHLI S S. Balloon kyphoplasty versus percutaneous vertebroplasty for osteoporotic vertebral body compression fractures: clinical and radiological outcomes[J]. Spine J, 2023, 23(4): 579-584. doi: 10.1016/j.spinee.2022.11.015
[6]	ElNOAMANY H. Percutaneous vertebroplasty: a first line treatment in traumatic non-osteoporotic vertebral compression fractures[J]. Asian Spine J, 2015, 9(2): 178-184. doi: 10.4184/asj.2015.9.2.178
[7]	CHANG J, YU D, JI J, et al. The association between the concentration of serum magnesium and postmenopausal osteoporosis[J]. Front Med (Lausanne), 2020, 7: 381.
[8]	程晴灏, 刘杰, 张文辉, 等. 镁与骨质疏松治疗的研究进展[J]. 宁夏医科大学学报, 2022, 44(9): 957-962. CHENG Q H, LIU J, ZHANG W H, et al. Research progress of magnesium in the treatment of osteoporosis[J]. Journal of Ningxia Medical University, 2022, 44(9): 957-962.
[9]	ZHU Y, CHENG J, YIN J, et al. Therapeutic effect of kyphoplasty and balloon vertebroplasty on osteoporotic vertebral compression fracture: a systematic review and meta-analysis of randomized controlled trials[J]. Medicine (Baltimore), 2019, 98(45): e17810. DOI: 10.2106/JBJS.RVW.21.00045.
[10]	朱振标, 李兴中, 刘亦恒, 等. 局部麻醉下经皮椎体成形术和经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折的临床效果比较[J]. 北京医学, 2021, 43(8): 811-814. ZHU Z B, LI X Z, LIU Y H, et al. Comparison of clinical effects of percutaneous vertebroplasty under local anesthesia and percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fractures[J]. Beijing Medical Journal, 2019, 43(8): 811-814.
[11]	ZHAO P, GUO A, TAN Z, et al. The evaluation of the treatment for old osteoporotic vertebral compression fracture pain by percutaneous vertebroplasty[J]. Medicine (Baltimore), 2020, 99(27): e20479. DOI: 10.1097/MD.0000000000020479.
[12]	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 AN Z C, CHEN C, DONG L Q, et al. Risk factors for adjacent segment refracture after percutaneous kyphoplasty[J]. Chinese Journal of General Practice, 2012, 20(4): 591-593, 712. doi: 10.16766/j.cnki.issn.1674-4152.002407
[13]	TAN L, WEN B, GUO Z, et al. The effect of bone cement distribution on the outcome of percutaneous vertebroplasty: a case cohort study[J]. BMC Musculoskelet Disord, 2020, 21(1): 541. doi: 10.1186/s12891-020-03568-9
[14]	姚龚, 沈忆新, 李敏, 等. 骨水泥不同弥散方式对椎体成形术后生物力学影响的有限元分析[J]. 中国骨伤, 2021, 34(8): 732-737. YAO G, SHEN Y X, LI M, et al. Biomechanical effects of different bone cement diffusion patterns after vertebroplasty: finite element analysis[J]. China Journal of Orthopaedics and Traumatology, 2021, 34(8): 732-737.
[15]	WANG D, LI Y, YIN H, et al. Three-dimensional finite element analysis of optimal distribution model of vertebroplasty[J]. Ann Palliat Med, 2020, 9(3): 1062-1072. doi: 10.21037/apm-20-955
[16]	HUANG S, ZHU X, XIAO D, et al. Therapeutic effect of percutaneous kyphoplasty combined with anti-osteoporosis drug on postmenopausal women with osteoporotic vertebral compression fracture and analysis of postoperative bone cement leakage risk factors: a retrospective cohort study[J]. Orthop Surg Res, 2019, 14(1): 452. doi: 10.1186/s13018-019-1499-9
[17]	HE S, ZHANG Y, LV N, et al. The effect of bone cement distribution on clinical efficacy after percutaneous kyphoplasty for osteoporotic vertebral compression fractures[J]. Medicine(Baltimore), 2019, 98(50): e18217. DOI: 10.1097/MD.0000000000018217.
[18]	PIAZZOLLA A, SOLARINO G, LAMARTINA C, et al. Vertebral bone marrow edema (VBME) in conservatively treated acute vertebral compression fractures (VCFs): evolution and clinical correlations[J]. Spine (Phila Pa 1976), 2015, 40(14): E842-E848. doi: 10.1097/BRS.0000000000000973
[19]	XU K, LI Y L, SONG F, et al. Influence of the distribution of bone cement along the fracture line on the curative effect of vertebral augmentation[J]. Int Med Res, 2019, 47(9): 4505-4513. doi: 10.1177/0300060519864183
[20]	孙炜俊. 骨水泥在椎体骨折线内弥散情况对椎体成形术治疗效果的影响[J]. 中外医学究, 2019, 17(23): 136-138. SUN W J. The influence of bone cement diffusion in vertebral fracture line on the therapeutic effect of vertebroplasty[J]. Chinese And Foreign Medical Research, 2019, 17(23): 136-138.
[21]	饶敏杰, 李亦男, 张功恒, 等. 唑来膦酸对老年性椎体压缩骨折患者椎体成形术后骨密度的影响[J]. 中华全科医学, 2021, 19(3): 383-386. doi: 10.16766/j.cnki.issn.1674-4152.001816 RAO M J, LI Y N, ZHANG G H, et al. Effect of zoledronic acid combined with percutaneous vertebroplasty on osteoporotic compression fractures in the elderly patients[J]. Chinese Journal of General Practice, 2021, 19(3): 383-386. doi: 10.16766/j.cnki.issn.1674-4152.001816