Risk Factors Of Recurrent Fractures Of Adjacent Vertebrae In Patients With Osteoporotic Vertebral Compression Fractures Of Thoracic Spine After Percutaneous Vertebroplasty

Objective:To analyze the risk factors of adjacent vertebral refracture after percutaneous vertebroplasty(PVP)in patients with single-segment thoracic osteoporotic vertebral compression fracture(OVCF).Methods:From January 2021 to June 2022,180 patients with single-segment thoracic OVCF treated with PVP in the Department of Orthopedics,the Spinal Department of the First Affiliated Hospital of Guangxi University of Chinese Medicine were retrospectively analyzed.The patient’s age,gender,Body Mass Index(BMI),injured vertebral segment,trauma,endplate fracture,Quantitative CT(QCT)of bone mineral density were collected.QCT value,bone cement injection volume,bone cement leakage,bone cement diffusion,preoperative injured vertebral height,postoperative recovery rate of injured vertebral height,postoperative local Cobb Angle,postoperative correction value of Cobb Angle,postoperative insistence on lumbar muscle exercise and other data.First,the two groups of data were collected for single factor analysis,the measurement data was tested by t test,and the count data was tested byX~2test.P<0.05,the difference was statistically significant.Multivariate Logistic regression analysis was used to analyze the statistically significant differences.Results:A total of 180 patients with thoracic OVCF who underwent single-stage percutaneous vertebroplasty were enrolled in this study,including 49 males and 131 females.During the follow-up period,39patients(21.7%)had refracture,including 23 patients(12.8%)with adjacent vertebral refracture and 141 patients(78.3%)without refracture.The patients without recurrence of vertebral fracture were set as the control group,and the patients with adjacent vertebral fracture were set as the observation group.There were 164 cases in the observation group and the control group.There were 5 males and 18 females in the observation group,with an average age of 74.00±8.42 years and an average QCT value of 41.96±18.90 mg/cm3.There were 41 males and 100 females in the control group,with an average age of 73.79±8.072 years and an average QCT value of 53.82±17.50 mg/cm3.Univariate analysis showed that there were significant differences in BMI,QCT value,endplate fracture,bone cement leakage to intervertebral disc,bone cement diffusion distribution,postoperative high vertebral height recovery rate and bone cement injection volume between the two groups(P<0.05).There was no significant difference in gender,age,postoperative Cobb Angle correction,postoperative local Cobb Angle,fracture segment,whether to adhere to the lumbar and back muscle exercise,and external force injury between the two groups(P>0.05).The factors with statistically significant differences in univariate analysis were included in multivariate binary Logistic regression analysis.The multivariate regression analysis showed that QCT value,bone cement leakage in intervertebral disc,and bone cement injection volume P<0.05,the difference was statistically significant;There was no significant difference in BMI,endplate fracture,bone cement dispersion distribution and postoperative vertebral height recovery rate(P>0.05).Conclusions:1.Low QCT value,high cement injection volume and cement leakage into intervertebral disc are independent risk factors for adjacent vertebral refracture in thoracic OVCF patients.2.The lower the BMD,the higher the incidence of adjacent vertebral refracture.Anti-osteoporosis treatment and monitoring the change of bone mass after operation are the key issues to prevent adjacent vertebral refracture.