标题：单节段骨质疏松性椎体压缩骨折患者PKP术后再塌陷的危险因素

      作者：梁冠文，高博，康银辉，尚玉龙    宝鸡市人民医院骨科，陕西 宝鸡 721000

      卷次： 2023年34卷8期

      【摘要】 目的 探讨单节段骨质疏松性椎体压缩骨折(OVCF)患者经皮椎体后凸成形术(PKP)术后再塌陷的危险因素，为改善患者预后提供相关指导。方法 回顾性分析2019年1月至2021年1月于宝鸡市人民医院骨科行PKP手术治疗的139例单节段OVCF患者的临床资料。术后随访1年，根据末次随访时X线复查结果，将所有患者分为再塌陷组20例和未塌陷组119例。对收集、测量的病例临床资料进行单因素分析，并对单因素分析中差异有统计学意义的指标进行多因素Logistic回归分析，由此得出影响单节段OVCF患者PKP术后再塌陷的危险因素。结果 单因素分析结果显示，两组患者的年龄、性别、体质量指数(BMI)、手术椎体、术椎压缩率、术前及术后Cobb角、骨水泥注入量、骨水泥有无渗漏比较差异均无统计学意义(P>0.05)，而两组患者的术椎前缘高度恢复率、骨密度T值、骨水泥分布、骨水泥弥散类型、骨水泥未与上下终板同时接触比较，差异均有统计学意义(P<0.05)；经多因素Logistic回归分析结果显示，术椎前缘高度恢复过度、骨水泥呈团块状分布、骨水泥呈致密型、骨水泥未与上下终板同时接触均是影响单节段OVCF患者PKP术后再塌陷的危险因素(P<0.05)。结论 部分单节段OVCF患者存在PKP术后再塌陷的状况，主要受术椎前缘高度恢复过度、骨水泥呈团块状分布、骨水泥呈致密型、骨水泥未与上下终板同时接触等危险因素的影响，临床应采取针对性的干预措施，以降低术后再塌陷的发生率，促进患者预后恢复。
      【关键词】 骨质疏松性椎体压缩骨折；单节段；经皮椎体后凸成形术；塌陷；危险因素
      【中图分类号】 R683.2 【文献标识码】 A 【文章编号】 1003—6350（2023）08—1106—04

Risk factors for re-collapse after percutaneous kyphoplasty in patients with single-segment osteoporotic vertebralcompression fractures.
LIANG Guan-wen, GAO Bo, KANG Yin-hui, SHANG Yu-long. Department of Orthopedics, BaojiPeople's Hospital, Baoji 721000, Shaanxi, CHINA
【Abstract】 Objective To investigate the risk factors of re-collapse after percutaneous kyphoplasty (PKP) in pa-tients with single-segment osteoporotic vertebral compression fracture (OVCF), and to provide relevant guidance for im-proving the prognosis of patients. Methods The clinical data of 139 patients with single-segment OVCF who underwentPKP surgery in the Department of Orthopedics, Baoji People's Hospital from January 2019 to January 2021 were retrospec-tively analyzed. The patients were followed up for 1 year after operation. According to the results of X-ray reexaminationat the last follow-up, the patients were divided into re-collapse group (n=20) and non-collapse group (n=119). Univariateanalysis was performed on the clinical data collected and measured, and the indicators with statistically significant differ-ences in univariate analysis were analyzed by multivariate Logistic regression, so as to determine the risk factors affectingre-collapse after PKP in patients with single-segment OVCF. Results Univariate analysis showed that there were no sta-tistically significant differences in age, gender, body mass index (BMI), operative vertebral body, compression rate of oper-ative vertebral body, preoperative and postoperative Cobb angle, bone cement injection amount, and bone cement leakagebetween the two groups (P>0.05). There were statistically significant differences in the recovery rate of preoperative anteri-or vertebral height, bone mineral density T value, bone cement distribution, bone cement diffusion type, and failure ofbone cement in contact with upper and lower endplates between the two groups (P<0.05). Multivariate Logistic regressionanalysis showed that excessive recovery of anterior vertebral height, lumpy distribution of bone cement, dense type ofbone cement, and failure of bone cement in contact with upper and lower endplates were risk factors for postoperativere-collapse in patients with single-segment OVCF (P<0.05). Conclusion Some patients with single-segment OVCF havethe condition of re-collapse after PKP, which is mainly affected by the risk factors such as excessive recovery of anteriorvertebral height, lumpy distribution of bone cement, dense type of bone cement, and failure of bone cement in contact withupper and lower endplates. Clinically, targeted interventions should be taken to reduce the incidence of postoperativere-collapse and promote the recovery of patients' prognosis.
      【Key words】 Osteoporotic vertebral compression fracture; Single-segment; Percutaneous kyphoplasty; Collapse;Risk factors