基于脊柱-骨盆矢状面参数、临床特征分析骨质疏松性椎体压缩骨折患者经皮椎体后凸成形术后邻近椎体继发骨折的影响因素

doi:10.3969/j.issn.1006-5725.2026.06.023

Abstract

Abstract:

Objective To analyze the influencing factors for adjacent vertebral compression fractures （AVCF） after percutaneous kyphoplasty （PKP） in patients with osteoporotic vertebral compression fractures （OVCF）， taking into account the sagittal parameters of the spine-pelvis， fracture characteristics， and treatment-related clinical features. Methods The research subjects were selected from OVCF patients admitted to the hospital between November 2020 and August 2023. A total of 240 cases were included， and their clinical data were retrospectively analyzed. All the patients underwent PKP surgery and were followed up for 2 years. Based on whether the selected patients experienced AVCF during the follow-up period， they were divided into the occurrence group （54 cases） and the non-occurrence group （186 cases）. The clinical data and spinal pelvic sagittal plane parameters of the two groups were compared， and the risk factors were analyzed by multivariate Logistic regression analysis. The predictive value of the regression equation was analyzed by receiver operating characteristic （ROC） curves. Results The proportions of patients with diabetes， Ⅱ/Ⅲ degree fracture compression， initial fracture site T₁₀-L₂， bone cement intervertebral disc leakage， multi-segment fracture， and intervertebral disc injury in the occurrence group were 53.70%， 62.96%， 72.22%， 40.74%， 44.44%， and 33.33%， respectively， which were higher than those of 24.19%， 47.31%， 45.70%， 13.44%， 19.35%， and 13.98% in the non-occurrence group. The recovery rate of vertebral body height was lower than that in the non-occurrence group， and the TK， SVA， and TPA were higher than those in the non-occurrence group （P < 0.05）. Diabetes （OR = 2.408）， Ⅱ/Ⅲ degree fracture compression （OR = 2.838）， bone cement disc leakage （OR = 1.547）， multi-level fracture （OR = 2.155）， disc injury （OR = 3.043）， elevated TK （OR = 2.081）， elevated SVA （OR = 2.298）， and elevated TPA （OR = 1.636） were independent risk factors for AVCF in OVCF patients after PKP （P < 0.05）. The increased vertebral height recovery rate （OR = 0.328） was an independent protective factor （P < 0.05）. A regression equation was constructed： logit （P） = -7.087 + diabetes × 0.879 + fracture compression degree × 1.043 + bone cement intervertebral disc leakage × 0.436 + multi-level fracture × 0.768 + intervertebral disc injury × 1.113 - vertebral height recovery rate × 1.114 + TK × 0.733 + SVA × 0.832 + TPA × 0.436. The construction of the Logistic multiple regression diagnostic regression equation is effective. The ROC curve shows that when logit （P） > 0.174， the area under the curve （AUC） value is 0.898， and the diagnostic sensitivity and specificity are 83.33% and 82.80%， respectively. Conclusions Diabetes， Ⅱ/Ⅲ degree fracture compression， bone cement disc leakage， multi-level fracture， disc injury， elevated TK， elevated SVA， and elevated TPA were identified as independent risk factors for AVCF in OVCF patients after PKP， the increased vertebral height recovery rate was an independent protective factor. The regression equation constructed exhibited a high predictive value.

Key words: osteoporotic vertebral compression fracture, percutaneous kyphoplasty, spinal pelvic sagittal plane parameters, adjacent vertebral bodies, influencing factors

CLC Number:

R683.2

Wei GONG,Tianle GAO,Jin WANG. Analysis of influencing factors for secondary fractures in adjacent vertebrae after percutaneous kyphoplasty in patients with osteoporotic vertebral compression fractures based on sagittal parameters of the spine-pelvis， fracture characteristics， and treatment-related clinical features[J]. The Journal of Practical Medicine, 2026, 42(6): 1088-1096.

Figures/Tables 7

Tab.1

Comparison of clinical data and spinal pelvic sagittal plane parameters between two groups"

因素	发生组（n = 54）	未发生组（n = 186）	t/χ² 值	P值
外伤史/［例（%）］	14（25.93）	40（21.51）	0.469	0.493
高血压/［例（%）］	17（31.48）	43（23.12）	1.561	0.211
糖尿病/［例（%）］	29（53.70）	45（24.19）	17.089	< 0.001
冠心病/［例（%）］	11（20.37）	33（17.74）	0.193	0.660
术前骨密度/SD	2.43 ± 0.21	2.41 ± 0.19	0.665	0.507
骨折至入院时间/［例（%）］			0.461	0.497
≤ 24 h	21（38.89）	82（44.09）
> 24 h	33（61.11）	104（55.91）
骨折压缩程度/［例（%）］			4.102	0.043
Ⅰ度	20（37.04）	98（52.69）
Ⅱ度/Ⅲ度	34（62.96）	88（47.31）
AO分型/［例（%）］			1.891	0.059
A1	46（85.19）	134（72.04）
A2	1（1.85）	12（6.45）
A3	4（7.41）	21（11.29）
A4	3（5.56）	19（10.22）
初始骨折部位/［例（%）］			11.789	0.001
T₁₀—L₂	39（72.22）	85（45.70）
非T₁₀—L₂	15（27.78）	101（54.30）
骨水泥量/mL	3.98 ± 1.02	3.87 ± 0.97	0.725	0.469
骨水泥椎间盘渗漏/［例（%）］	22（40.74）	25（13.44）	19.805	< 0.001
椎体高度恢复率/%	8.54 ± 2.03	10.51 ± 3.28	4.183	< 0.001
存在陈旧性骨折/［例（%）］	11（20.37）	26（13.98）	1.311	0.252
前壁骨折/［例（%）］	28（51.85）	88（47.31）	0.345	0.557
上终板塌陷/［例（%）］	35（64.81）	98（52.69）	2.491	0.115
多节段骨折/［例（%）］	24（44.44）	36（19.35）	14.050	< 0.001
终板损伤/［例（%）］	52（96.30）	174（93.55）	0.184^*	0.668
骨折线达终板/［例（%）］	34（62.96）	97（52.15）	1.974	0.160
椎间盘损伤/［例（%）］	18（33.33）	26（13.98）	10.471	0.001
手术方式/［例（%）］	29（53.70）	91（48.92）	0.382	0.536
骨水泥分布形态/［例（%）］			0.499	0.617
Ⅰ型	36（66.67）	126（67.74）
Ⅱ型	12（22.22）	15（8.06）
Ⅲ型	2（3.70）	7（3.76）
Ⅳ型	3（5.56）	33（17.74）
Ⅴ型	1（1.85）	5（2.69）
TK/°	42.54 ± 12.54	35.43 ± 8.32	4.880	< 0.001
TLK/°	11.43 ± 3.12	10.95 ± 2.08	1.320	0.188
SVA/mm	26.54 ± 6.32	13.65 ± 4.02	18.002	< 0.001
TPA/ mm	34.54 ± 9.17	23.98 ± 6.27	9.731	< 0.001
PT/°	21.54 ± 4.87	21.39 ± 4.61	0.208	0.836

Tab.1

Fig.1

Tab.2

Tab.3

Fig.2

Fig.3

Fig.4

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因素	变量性质	赋值
术后AVCF发生情况	Y	0=无，1=有
糖尿病	X₁	0=无，1=有
骨折压缩程度	X₂	0=Ⅰ度，1=Ⅱ度/Ⅲ度
初始骨折部位	X₃	0=非T₁₀—L₂，1=T₁₀—L₂
骨水泥椎间盘渗漏	X₄	0=无，1=有
多节段骨折	X₅	0=否，1=是
椎间盘损伤	X₆	0=无，1=有
椎体高度恢复率	X₇	原值输入
TK	X₈	原值输入
SVA	X₉	原值输入
TPA	X₁₀	原值输入

变量	β	SE	Wald χ²	P值	OR	95%CI
有糖尿病	0.879	0.243	13.085	< 0.001	2.408	1.496 ~ 3.878
Ⅱ度/Ⅲ度骨折压缩	1.043	0.490	4.531	0.033	2.838	1.086 ~ 7.414
初始骨折部位为T₁₀—L₂	0.471	0.511	0.850	0.357	1.602	0.588 ~ 4.360
骨水泥椎间盘渗漏	0.436	0.101	18.635	< 0.001	1.547	1.269 ~ 1.885
多节段骨折	0.768	0.203	14.313	< 0.001	2.155	1.448 ~ 3.209
椎间盘损伤	1.113	0.497	5.015	0.025	3.043	1.149 ~ 8.062
椎体高度恢复率	-1.114	0.213	27.353	< 0.001	0.328	0.216 ~ 0.498
TK	0.733	0.117	39.250	< 0.001	2.081	1.655 ~ 2.618
SVA	0.832	0.234	12.642	< 0.001	2.298	1.453 ~ 3.635
TPA	0.492	0.118	17.385	< 0.001	1.636	1.298 ~ 2.061

Analysis of influencing factors for secondary fractures in adjacent vertebrae after percutaneous kyphoplasty in patients with osteoporotic vertebral compression fractures based on sagittal parameters of the spine-pelvis， fracture characteristics， and treatment-related clinical features

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