骨质疏松椎体压缩性骨折PVP术后再骨折相关危险因素研究

doi:10.3969/j.issn.1009-976X.2025.01.008

摘要/Abstract

摘要： 目的骨质疏松症引起骨折的危险性增加,特别是常见的椎体压缩性骨折（OVCF）。行经皮椎体成形术（PVP）治疗,效果显著,但术后有再次骨折的危险。研究再骨折影响因素对于改善预防策略和治疗至关重要。方法回顾性分析2021年4月至2023年6月在双峰县人民医院接受PVP术的骨质疏松椎体压缩性骨折患者的临床资料。共收集409例患者的相关信息,将其分为再骨折组和非再骨折组。对患者的年龄、性别、骨折后手术时间、初始骨折椎体数、手术穿刺方式、骨水泥注入量、是否骨水泥渗漏、总蛋白数、球蛋白数、预后营养指数（PNI）、白蛋白/纤维蛋白原比值AFR、CT值、体重、是否规律抗骨质疏松治疗等因素进行单因素分析,并将有影响的因素纳入Logistics多因素回归分析以确定相关的危险因素。结果单因素分析显示,骨折术后手术时间、球蛋白、白蛋白数、淋巴细胞绝对值、纤维蛋白原、PNI、白蛋白/纤维蛋白原、CT值、手术穿刺方式、是否规律抗骨质疏松治疗等因素与再骨折发生有显著关联（P<0.05）。多因素回归分析结果显示,手术穿刺方式（单侧穿刺）（OR=2.181,95%CI：1.249-3.809）、PNI（OR=0.876,95%CI：0.821-0.934）、CT值（HU）（OR=0.961,95%CI：0.948-0.974）、球蛋白（OR=1.078,95% CI：1.013-1.147）,没有规律抗骨质疏松（OR=1.816,95%CI：1.029-3.206）与再骨折发生之间存在显著关联（P<0.05）。结论手术穿刺方式、PNI、CT值、球蛋白数、是否规律抗骨质疏松治疗是骨质疏松椎体压缩性骨折PVP术后再骨折的危险因素,这些因素的评估可能有助于预测患者再骨折的风险,为临床干预和治疗策略的制定提供参考。

关键词: 骨质疏松, 椎体压缩性骨折, PVP术, 再骨折, 危险因素

Abstract: Objective This study aimed to explore the relevant risk factors for recurrent fractures after percutaneous vertebroplasty （PVP） in patients with osteoporotic vertebral compression fractures. Methods A retrospective analysis was conducted on the clinical data of patients with OVCF who underwent PVP at Shuangfeng County People's Hospital between April 2021 and June 2023. Relevant information from 409 patients was collected and categorized into a re-fracture group and a non-re-fracture group. Univariate analysis was performed on factors such as patient age, gender, time to surgery after fracture, number of initially fractured vertebrae, surgical puncture method, bone cement injection volume, presence of bone cement leakage, total protein level, globulin level, prognostic nutritional index （PNI）, albumin/fibrinogen ratio （AFR）, CT value, body weight, and whether regular anti-osteoporosis treatment was administered. Influential factors were then included in a multivariate logistic regression analysis to identify associated risk factors. Results Univariate analysis revealed significant associations between factors such as time to surgery after fracture, globulin level, albumin level, absolute lymphocyte count, fibrinogen level, PNI, AFR, CT value, surgical puncture method, and regular anti-osteoporosis treatment with the occurrence of re-fracture （P<0.05）. Multivariate logistic regression analysis showed significant relationships between unilateral puncture as the surgical puncture method （OR=2.181, 95% CI： 1.249-3.809）, PNI （OR=0.876, 95%CI： 0.821-0.934）, CT value （HU）（OR=0.961, 95%CI： 0.948-0.974）, globulin level （OR=1.078, 95% CI： 1.013-1.147）, and lack of regular anti-osteoporosis treatment （OR=1.816, 95% CI： 1.029-3.206） with the occurrence of re-fracture （P<0.05）. Conclusion Based on our findings, surgical puncture method, PNI, CT value, globulin level, and whether regular anti-osteoporosis treatment is administered are independent risk factors for re-fracture after PVP for OVCF. Assessing these factors may help predict the risk of re-fracture among patients and provide a reference for clinical intervention and treatment strategy formulation.

Key words: osteoporosis, vertebral compression fractures, percutaneous vertebroplasty, recurrent fractures, risk factors

中图分类号:

R683.2

刘思定, 王云. 骨质疏松椎体压缩性骨折PVP术后再骨折相关危险因素研究[J]. 岭南现代临床外科, 2025, 25(01): 41-46.

LIU Si-ding, WANG Yun. Study on the risk factors associated with refracture after PVP for osteoporotic vertebral compression fractures[J]. Lingnan Modern Clinics In Surgery, 2025, 25(01): 41-46.

参考文献

[1] 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.
[2] Kutsal FY, Ergin Ergani GO.Vertebral compression fractures: Still an unpredictable aspect of osteoporosis[J].Turk J Med Sci, 2021, 51(2): 393-399.
[3] 许正伟, 郝定均, 程黎明, 等. 骨质疏松性椎体压缩骨折椎体强化术后康复治疗指南(2022版)[J].中华创伤杂志, 2022, 38(11): 961-972
[4] Kan SL, Yuan ZF, Chen LX, et al.Which is best for osteoporotic vertebral compression fractures: balloon kyphoplasty, percutaneous vertebroplasty or non-surgical treatment? A study protocol for a Bayesian network meta-analysis[J].BMJ Open, 2017, 7(1):e012937.
[5] Ding JK, Zhao B, Zhai YF.Subsequent fractures after vertebroplasty in osteoporotic vertebral fractures: a meta-analysis[J].Neurosurg Rev, 2022, 45(3): 2349-2359.
[6] Dai C, Liang G, Zhang Y, et al.Risk factors of vertebral re-fracture after PVP or PKP for osteoporotic vertebral compression fractures, especially in Eastern Asia: a systematic review and meta-analysis[J].J Orthop Surg Res, 2022, 17(1): 161.
[7] 张惠林, 殷世武, 项廷淼, 等. 单侧及双侧经皮椎体成形术治疗骨质疏松性胸腰椎骨折临床疗效比较[J].临床外科杂志, 2023, 31(1): 89-92.
[8] 李钿, 陈太秋, 洪金, 等. 脊神经后支阻滞联合椎体后凸成形术治疗骨质疏松性椎体压缩性骨折的前瞻性对照研究[J].岭南现代临床外科, 2023, 23(2): 145-151.
[9] Zhang F, Zhao QM, Ni XH, et al.Comparison of unilateral and bilateral puncture percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fractures[J].Neurosciences (Riyadh), 2021, 26(3): 236-241.
[10] 廖昌和, 朱古鑫, 马航展. PKP术后骨水泥分布对邻近椎体再发骨折的影响及相关危险因素分析[J].实用骨科杂志, 2024, 30(3): 232-237.
[11] Mo L, Wu Z, Liang D, et al.Influence of bone cement distribution on outcomes following percutaneous vertebroplasty: a retrospective matched-cohort study[J].J Int Med Res, 2021, 49(7): 3000605211022287.
[12] Kreienbuehl AS, Rogler G, Emanuel B, et al.Bone health in patients with inflammatory bowel disease[J].Swiss Med Wkly, 2024, 154: 3407.
[13] Nagai T, Uei H, Nakanishi K.Association Among Geriatric Nutritional Risk Index and Functional Prognosis in Elderly Patients with Osteoporotic Vertebral Compression Fractures[J].Indian J Orthop, 2022, 56(2): 338-344.
[14] 王文章, 麦春华, 许东峰, 等. 基于年龄、椎体松质骨CT值预测QCT值[J].现代医用影像学, 2024, 33(1): 90-93.
[15] 周凤云, 闫东, 王玲, 等. 腰椎体积CT值对诊断骨质疏松症的应用价值[J].中国骨质疏松杂志, 2023, 29(9): 1272-1277.
[16] Li YL, Wong KH, Law MW, et al.Opportunistic screening for osteoporosis in abdominal computed tomography for Chinese population[J].Arch Osteoporos, 2018, 13(1): 76.
[17] Mooney J, Morgan S, Brockington D, et al.Inter-Rater Reliability and Correlation of L1 Hounsfield Unit Measurements with DXA Scores[J].J Clin Densitom, 2022, 25(4): 668-673.
[18] Peng F, Sun L, Chen T, et al.Albumin-globulin ratio and mortality in patients on peritoneal dialysis: a retrospective study[J].BMC Nephrol, 2020, 21(1): 51.
[19] Pai AY, Sy J, Kim J, et al.Association of serum globulin with all-cause mortality in incident hemodialysis patients[J].Nephrol Dial Transplant, 2022, 37(10): 1993-2003.
[20] Ye Y, Chen W, Gu M, et al.Serum globulin and albumin to globulin ratio as potential diagnostic biomarkers for periprosthetic joint infection: a retrospective review[J].J Orthop Surg Res, 2020, 15(1): 459.
[21] 李兰亚, 伍广, 屠涛. 类风湿关节炎并发OP患者免疫球蛋白、淋巴细胞亚群、IL-27及IL-6水平的研究[J].国际免疫学杂志, 2022, 45(2): 158-163.
[22] Dong A, Fei X, Huang Y, Huang Y.Efficacy of anti-osteoporosis treatment for men with osteoporosis: a meta-analysis[J].J Bone Miner Metab, 2023, 41(2): 258-267.
[23] 中华医学会骨质疏松和骨矿盐疾病分会. 原发性骨质疏松症诊疗指南(2022)[J].中国全科医学, 2023, 26(14): 1671-1691.
[24] Boucher E, Rosgen B, Lang E.Efficacy of calcitonin for treating acute pain associated with osteoporotic vertebral compression fracture: an updated systematic review[J].Cjem, 2020, 22(3): 359-367.