关键词: 骨质疏松性椎体压缩骨折, 椎体成形术, 再骨折, 椎体裂隙征

Abstract: Objective  To investigate the risk factors of postoperative vertebral body refracture after percutaneous vertebroplasty(PVP) in the treatment of thoracolumbar osteoporotic compression fracture.Methods  The radiological and clinical data of 1258 patients who underwent single-level PVP surgery for thoracolumbar vertebral compression fracture in our hospital from January 1,2015 to December 31,2020 were retrospectively analyzed.Gender,age,body mass index(BMI),bone mineral density(BMD),surgical approach,injection amount of cement,diffusion state of,leakage,vertebral height restores,kyphotic angle reduction,wedge angle reduction of vertebral body,postoperative anti-osteoporosis drug application and other radiological and clinical data of patients were collected and analyzed by univariate and multivariate analysis.The differences of these parameters in the refracture group and the nonrefracture group were compared to evaluate the correlation between these factors and postoperative vertebral refracture.Results  A total of 247 patients were included in this study.The incidence of refracture was 3.90% in 49 patients.Univariate analysis showed that large kyphotic angle,intravertebral cleft sign,endplate cortical disruption,small injection amount of bone cement,non-contact between bone cement and endplate,and high reduction rate of vertebral body were risk factors for vertebral refracture after PVP.Multivariate analysis of these factors showed that large injection amount of bone cement(OR=0.37，95%CI：0.190.55，P=0.018) was a protective factor for vertebral refracture after PVP,and preoperative endplate cortical disruption(OR=2.86，95%CI：1.14~7.53，P=0.026),preoperative intravertebral cleft sign(OR=18.15，95%CI：3.07~44.79，P=0.003),large vertebral reduction rate(OR=3.58，95%CI：1.38~8.40，P=0.007),and poor contact between bone cement and endplate(OR=3.01，95%CI：1.92~10.65，P=0.004) were independent risk factors for vertebral refracture after PVP.Conclusion  In this study,it was found that small injection amount of bone cement,endplate cortical disruption before surgery,intravertebral cleft sign,large vertebral reduction rate,and poor contact between bone cement and endplate were independent risk factors for postoperative refracture after PVP treatment of osteoporotic compression fractures in the elderly thoracolumbar spine.

Key words: osteoporotic vertebral compression fracture；vertebroplasty, refracture；intravertebral cleft sign