经皮椎体后凸成形术相邻节段退变的相关因素△（开放获取）

Factors related to adjacent segment degeneration secondary to percutaneous kyphoplasty (OA)

摘要:

[目的] 探讨经皮椎体后凸成形术 （percutaneous kyphoplasty, PKP） 治疗后相邻节段椎间盘退变发生的危险因素。 [方法] 2020 年 1 月—2021 年 9 月本院收治的 162 例 PKP 患者纳入本研究，根据术后随访 2 年相邻节段椎间盘是否发生退变分为退变组与未退变组，单因素及多因素逻辑回归分析退变发生的危险因素，且通过逻辑回归构建预测模型，ROC 曲线评估预测效能。[结果]162 例患者中，PKP 术后 2 年 25 例发生相邻节段椎间盘退变，占 15.4%。单因素比较：退变组年龄 [(73.0±6.6) 岁 vs (67.9±7.9) 岁, P=0.003]、吸烟史占比 [例, 是/否, (17/8) vs (62/75), P=0.036]、术前邻近节段退变占比 [例, 是/否, (9/16) vs (24/ 113), P=0.035]、骨水泥注入量 [(4.1±1.0) ml vs (3.1±0.9) ml, P＜0.001]、骨水泥渗漏占比 [例, 是/否, (10/15) vs (23/114), P=0.008]、术后即刻 Cobb 角 [(11.5±2.7)° vs (9.8±2.1)°, P＜0.001]、椎体高度恢复率 [(12.0±2.6)% vs (8.2±2.3)%, P＜0.001] 均显著大于未退变组，退变组术前 BMD [(-3.2±0.8) vs (-2.6±0.5), P＜0.001] 显著小于未退变组。多因素逻辑回归分析显示，骨水泥注入量 （OR=2.653, P= 0.044）、椎体高度恢复率 （OR=2.045, P＜0.001）、年龄 （OR=1.199, P=0.016） 是相邻节段椎间盘退变发生的独立危险因素。而 BMD （OR=0.279, P=0.035） 是其保护因素。各独立影响因素预测退变的 AUC 分别为：年龄 0.804、BMD 0.753、骨水泥注入量 0.761、椎体高度恢复率 0.878。基于逻辑回归独立因素的预测方程 AUC 为 0.960。[结论] 年龄大、低骨密度、骨水泥注入量大、椎体高度过度恢复是 PKP 术后相邻节段椎间盘退变发生的危险因素，临床需高度重视且对症处理。

Abstract:

[Objective] To explore the risk factors related to adjacent segment degeneration (ASD) after percutaneous kyphoplasty (PKP). [Methods] A total of 162 patients who received PKP in our hospital from January 2020 to September 2021 were included in this study. They were divided into a ASD group and a non-ASD group based on whether adjacent segment degeneration happened 2 years after the primary PKP. Multivariate logistic regression analyses were conducted to identify the risk factors for degeneration. A predictive model was constructed using logistic regression, and the predictive performance was evaluated using ROC curves. [Results] Among 162 patients, 25 cases (15.4%) experienced ASD 2 years after PKP surgery. As for univariate comparison, the ASD cohort proved significantly greater than the non-ASD group in terms of age [(73.0±6.6) years vs (67.9±7.9) years, P=0.003], proportion of smoking history [yes/no, (17/8) vs (62/75), P=0.036], proportion of previous ASD before surgery [yes/no, (9/16) vs (24/113), P=0.035], amount of bone cement injected [(4.1±1.0) ml vs (3.1±0.9) ml, P＜0.001], proportion of bone cement leakage [yes/no, (10/15) vs (23/114), P=0.008], Cobb angle immediately after surgery, [(11.5±2.7)° vs (9.8 ± 2.1)] and recovery rate of vertebral height [(12.0±2.6)% vs (8.2 ± 2.3)%, P＜0.001], whereas the former had significantly lower preoperative BMD than the latter [T value, (-3.2±0.8) vs (-2.6±0.5), P＜0.001]. As results of multivariate logistic regression analysis, more amount of bone cement injected (OR=2.653, P=0.044), higher vertebral height recovery rate (OR=2.045, P＜0.001), and older age (OR= 1.199, P=0.016) were the independent risk factors for ASD, while the greater BMD (OR=0.279, P=0.035) was a protective factor. The ROC areas under curve (AUCs) predicting ASD by independent factor were of 0.804 by age, 0.753 by BMD , 0.761 with bone cement volume injected, and 0.878 by vertebral height recovery rate, in contrast, of 0.960 by the prediction equation. [Conclusion]Advanced age, low bone density, large amount of bone cement injection, and excessive recovery of vertebral height are risk factors for ASD after PKP surgery, which should be highly valued and treated accordingly in clinical practice.