Analysis Of Risk Factors And Preventive Measures Of Recurrent Vertebral Fracture After Percutaneous Kyphoplasty

Objective:(1)To explore the risk factors of recurrent vertebral fracture after percutaneous kyphoplasty and injection of bone cement for osteoporotic vertebral compression fracture through single factor and multiple factor regression analysis,so as to provide certain theoretical basis for clinical;(2)In view of the possible risk factors,corresponding preventive measures are proposed to minimize the incidence of recurrent vertebral fractures in clinical practice.Research methods: The medical records of 100 patients with osteoporotic vertebral compression fracture who underwent single-segment percutaneous kyphoplasty in the Third Affiliated Hospital of Anhui Medical University from May 2018 to August 2019 were retrospectively analyzed.During the follow-up period,a total of 21 patients had recurrent vertebral fracture,which was set as the refracture group.The age of the patients between the groups was 68-88 years old,with an average of 76.86 ± 5.86 years old.The control group was 79 patients who did not have recurrent fracture,and the age of the patients between the groups was 56-85 years old,The average age was72.99 ± 7.10 years.Compare the age,sex ratio,bone cement injection volume,unilateral or bilateral puncture,whether the bone cement is symmetrically distributed across the midline,bone cement leakage,bone cement contacting the upper and lower endplates,preoperative fracture vertebral distribution,preoperative fracture compression degree,postoperative anti-osteoporosis drugs,preoperative bone mineral density,preoperative old vertebral fracture,postoperative Cobb angle change and postoperative anterior edge height recovery rate between the two groups,and conduct single factor independent sample t test,X ~2 Test and multivariate logistic regression analysis.Results:(1)100 cases were followed up for more than 2 years.In univariate analysis,the average age of patients in the control group(72.99 ± 7.141)was smaller than that in the refracture group(76.86 ± 6.002),and the difference was statistically significant(P<0.05);The value of bone mineral density(-3.22 ± 0.59)in the control group was higher than that in the refracture group(-3.65 ± 1.10),and the osteoporosis in the refracture group was more serious,the difference was statistically significant(P<0.05);With regard to the distribution of bone cement,54 patients(68.4%,54/79)in the control group had symmetrical bone cement crossing the midline,while only 9patients(42.9%,9/21)in the refracture group.The proportion of patients was significantly lower than that in the control group,and the difference was statistically significant(P<0.05);There were 22 patients(27.8%,22/79)in the control group who were exposed to the upper and lower end plates at the same time,and 12 patients(57.1%,12/21)in the refracture group.The proportion of patients was significantly higher than that in the control group,and the difference was statistically significant(P<0.05).Other factors include gender,degree of preoperative vertebral fracture,unilateral or bilateral puncture,amount of bone cement injection,leakage of bone cement,regular anti-osteoporosis drugs after operation,whether there is old vertebral fracture before operation,change of Cobb’s angle after operation and recovery rate of anterior edge height after operation.There was no significant difference between the two groups(P>0.05).(2)In multivariate regression logistic analysis,old age(P=0.011,OR=1.127),symmetrical distribution of bone cement across the midline(P=0.028,OR=0.280),simultaneous contact of bone cement with the upper and lower end plates(P=0.037,OR=3.253)and low bone density(P=0.046,OR=0.469)were independent risk factors for recurrent bone fracture after operation.Conclusion:(1)The elderly status,low bone mineral density,simultaneous contact of bone cement with upper and lower endplates during operation,and the distribution of bone cement not symmetrical across the midline are independent risk factors for recurrent vertebral fractures after kyphoplasty in patients with osteoporotic vertebral compression fractures.(2)For the elderly patients with osteoporotic vertebral compression fracture with low bone density value,it is necessary to do a good job of propaganda and education after operation,focus on preventing the occurrence of recurrent vertebral fracture,and the operator should improve the bone cement injection technology,control the distribution of bone cement during operation as much as possible,and reduce the incidence of recurrent vertebral fracture.