| Objective Based on the analysis of the risk factors of re fracture after conservative treatment and surgical minimally invasive surgery(PVP,PKP)treatment of osteoporotic vertebral compression fracture,this paper makes a basis analysis for reducing the probability of re fracture after conservative treatment and surgical minimally invasive surgery,and further expounds the effective prevention measures;discusses the first time of osteoporotic vertebral compression The change of kyphosis Cobb angle(°)and the height of the anterior edge of the diseased vertebra(mm)after fracture,first fracture treatment and re fracture can provide certain basis for reflecting the biomechanical change of vertebral fracture and re fracture,and then provide certain help for clinical treatment.Methods Study on the risk factors for the occurrence of re fracture of osteoporotic vertebral compression fracture: select the first-time inpatients and outpatients of osteoporotic vertebral compression fracture in our hospital(General Hospital of Ningxia Medical University)from March 2012 to March 2018,exclude the first-time vertebral treatment patients in other hospitals,non osteoporosis reasons,patients with vertebral compression fracture caused by severe violence and follow-up process The patients who lost their visit in.There were 451 cases of osteoporotic vertebral compression fracture with complete data.1.According to the different treatment methods of the first fracture,234 patients were treated conservatively,217 patients were treated with minimally invasive surgery(pvp120,pkp97).After the first treatment of vertebral fracture,patients with back pain were diagnosed as fresh re fracture by vertebral imaging.Among them,57 patients with re fracture in theconservative treatment were in the experimental group,177 patients without re fracture in the rest follow-up were in the control group;53 patients with re fracture in the surgical minimally invasive surgery(PVP,PKP)were in the experimental group,and 164 patients without re fracture in the rest follow-up were in the control group.2.To investigate the causes and the time interval between the first and second fractures in patients with conservative and minimally invasive surgery;3.To investigate the diagnosis and treatment process,general data,functional indexes and follow-up of the first vertebral fracture in the experimental group and the control group.In the conservative treatment,there were age,gender,BMI,bone mineral density(BMD)t-value,number of first vertebrae fractures,calcium and vitamin D use,the use of anti osteoporosis drugs,regular and sufficient sunshine(15-30 min skin exposure),drugs affecting bone metabolism and other chronic diseases;in the minimally invasive surgical treatment,there were age,gender,BMI,bone mineral density(BMD)t-value,number of first vertebrae fractures,calcium and vitamin D use,the use of anti osteoporosis drugs,regular and sufficient sunshine(15-30 min skin exposure),drugs affecting bone metabolism and other chronic diseases and leakage of bone cement.The data collected were analyzed by spss25.0 statistical software.The characteristics of the patients in the control group and the experimental group were analyzed under the conditions of conservative treatment and minimally invasive surgery.The significance of the data between the two groups and the relationship between the two groups and the occurrence of re fracture were compared.For the mechanical analysis of osteoporotic vertebral compression fracture: select the first osteoporotic vertebral compression fracture inpatients and outpatients in our hospital(Ningxia Medical University General Hospital)from March 2012 to March 2018,exclude the first vertebral treatment patients in other hospitals,non osteoporosis reasons,patients with vertebral compression fracture caused by serious violence and patients who lost their visitduring the follow-up process 。 There were 422 cases of osteoporotic vertebral compression fracture with complete data.Among them,221 cases were in conservative treatment group,109 cases in PVP group and 92 cases in PKP group.1.According to the different treatment methods of the first fracture,221 patients in the conservative group,109 patients in the PVP group and 92 patients in the PKP group were selected.After the first treatment,the first X-ray film was reexamined in all three groups.In the follow-up of the three groups of patients with back pain,imaging examination(X-ray film)can be confirmed as fresh patients with re fracture.Among them,37 patients in conservative treatment group,19 patients in PVP group and 16 patients in PKP group had re fracture.2.(1)to record the general conditions(gender,age,first fracture index,etc.)of the three groups;(2)to measure and calculate the first kyphosis Cobb angle(°)and the height of the front edge of the diseased vertebra(mm)of the conservative group,PVP group and PKP group according to the X-ray film;(3)to measure and calculate the first kyphosis Cobb angle(°)and the height of the front edge of the diseased vertebra(mm)of the three groups according to the X-ray film(4)According to the X-ray measurement and calculation of three groups of patients after the occurrence of re fracture,the Cobb angle(°),the height of the disease spine front edge(mm);(5)the data collected were analyzed by spss25.0 statistical software.After the first fracture,after the first treatment and after the second fracture,the changes of Cobb angle(°)and the height of the anterior edge of the diseased vertebrae(mm)were analyzed and compared.Results 1.Inter-fracture interval: 57 patients with re-fractures were treated conservatively in 10 years(accounting for 17.44%),1-5 years in 28 cases(accounting for 49.12%),5 years and 19 cases(accounting for 33.33%));Surgical minimally invasive surgery to treat 53 patients with re-fractures within 1 year 7 cases(13.21%),1-5 years 30 cases(56.60%),5 years and more 16 cases(30.19%).2.Re-fracture incentives: Conservative treatment of 57 patients with re-fracture and fall incentives in 27 cases(accounting for 47.37%),change of posture in 11 cases(accounting for19.30%),vehicle bumping in 5 cases(accounting for 8.77%),and other 5 cases((8.77%),9cases without cause(15.79%);minimally invasive surgery for 53 cases of re-fracture and fall25 cases(47.17%),11 posture changes(20.75%),bumps in cars 4 cases(7.55%),5 others(9.43%),and 8 cases(15.09%)without inducement.3.Univariate analysis: the conservative treatment group in the age group is 70 years old or older,female,bone mineral density T value(SD)is less than-3,number of first vertebral body fractures ≥2,calcium and vitamin D are not used according to the doctor’s advice Anti-osteoporosis drugs,accompanied by 2 or more other chronic diseases,compared with the control group,the difference was statistically significant(P <0.05);patients with surgical minimally invasive surgery in the experimental group were 70 years old or older,female,B-density T-value(SD)is less than-3,number of first vertebral body fractures ≥2,the use of calcium and vitamin D is not in accordance with the doctor’s instructions,the use of anti-osteoporosis drugs is not in accordance with the doctor’s instructions,and there are 2 or more types of chronic diseases And bone cement leakage,compared with the control group,the difference was statistically significant(P <0.05).4.Multivariate logistic regression analysis: The conservative treatment and surgical minimally invasive surgery univariate analysis results showed that meaningful variables were included in the logistic regression model for analysis and processing.The results showed that in conservative treatment,the age was greater than or equal to 70 years old,female,and bone mineral density T-value(SD)Less than-3,number of first vertebral body fractures ≥2,failure to use calcium and vitamin D as directed by the doctor,and use of anti-osteoporosis drugs as directed by the doctor are independent risks of osteoporotic vertebral compression fractures before fracture Factors: In the minimally invasive surgical treatment,the age is greater than orequal to 70 years old,the female,the bone mineral density T value(SD)is less than-3,number of first vertebral body fractures ≥2,the calcium and vitamin D are not used as directed,and the anti Osteoporotic drugs and bone cement leakage are independent risk factors for osteoporotic vertebral compression fractures before fractures.5.(1)there was no difference(P < 0.05)in the general conditions(age,gender,bone density,fracture index)of the three groups.(2)There was no significant difference in the Cobb angle(°)and the height of the anterior edge of the diseased vertebrae(mm)before and after the treatment of conservative treatment,PVP treatment and PKP treatment,P > 0.05,without statistical significance.There was no difference in the Cobb angle(°)and the height of the anterior edge of the diseased vertebrae(mm)after the first fracture in the three groups.(3)Compared with the three groups after treatment,the improvement of Cobb angle(° and mm)of kyphosis in PKP group was better than that in PVP group,and PvP group was better than that in conservative group.(4)Among 221 cases treated with conservative treatment,37cases(16.29%)had adjacent vertebral body re fracture,and 26 cases(17.43%)of 109 cases in PVP group had adjacent vertebral body re fracture,Among 92 cases in PKP group,21 cases(17.39%)suffered from re fracture of adjacent vertebral body.There were significant differences in Cobb angle(°) and height of anterior edge of diseased vertebral body(mm)between the three groups by one-way ANOVA(P < 0.05).It can be seen from the data that,compared with the conservative group,the posterior convex Cobb angle(°)of PVP group and PKP group increased significantly,and PvP group was more obvious;the disease vertebral front height(mm)of PVP group and PKP group was significantly lower than that of the conservative group,and PVP group was lower.Conclusion 1.The interval between re-fractures of osteoporotic vertebral compression fractures usually occurs within 1-5 years;falls are the main cause of fractures after osteoporotic vertebral compression fractures;2.Reasonable calcium,vitamin D,and anti-osteoporosis treatment are protective measures to prevent re-fracture after treatment of osteoporotic vertebral compression fractures;3.Bone cement leakage can increase the risk of re-fracture after osteoporotic vertebral compression fractures;4.Re-fracture is positively related to the severity of osteoporosis;5.Age and gender are uncontrollable factors for fractures after osteoporotic vertebral compression fractures;6.Compared with conservative treatment,PVP and PKP treatment of osteoporotic vertebral compression fractures can effectively improve the kyphosis Cobb angle and the height of the anterior edge of the vertebral body;7.Compared with conservative treatment,when the adjacent vertebral body re-fractures occur,PKP,PVP treatment of vertebral body re-fracture kyphosis Cobb angle vertebral body height change is greater,especially with PVP treatment. |
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