从中医证型角度探讨骨质疏松性椎体压缩骨折经骨水泥强化治疗后椎体再骨折的相关因素

To Investigate the Related Factors of Vertebral Refracture of Osteoporotic Vertebral Compression Fracture after Enhanced Treatment with Bone Cement from the Perspective of TCM Syndrome

摘要: 目的：从中医证型角度探讨经骨水泥强化治疗后的骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture, OVCF)患者椎体再骨折的相关因素。方法：回顾性分析了2020-01至2022-10于湖北省中西医结合医院骨科行经皮椎体后凸成形术(Percutaneous Kyphoplasty, PKP)及经皮椎体成形术(Percutaneous Vertebroplasty, PVP)治疗的257例OVCF患者，根据术后是否发生椎体再骨折，将病人分为再骨折组(39例)和未再骨折组(218例)，收集两组患者的临床资料，经单因素分析与多因素logistic回归分析确定术后椎体再骨折的独立相关因素。结果：两组性别、年龄、体质量指数、骨折病史、手术部位情况比较，差异均无统计学意义(P > 0.05)；两组在中医证型、骨密度、初始骨折椎体个数、骨水泥的渗漏比较，差异均有统计学意义(P < 0.05)；在中医证型中，两组肾阳虚证的差异无统计学意义(P > 0.05)，再骨折组的肝肾阴虚证、脾肾两虚证的比例更高，气滞血瘀证的比例更低，差异均有统计学意义(P < 0.05)；多因素Logistic回归分析结果显示，肝肾阴虚证、脾肾两虚证、骨密度、初始骨折椎体个数、骨水泥的渗漏均为OVCF患者骨水泥强化治疗后椎体再骨折的独立相关因素(OR > 1, P < 0.05)。结论：OVCF患者骨水泥强化治疗后椎体再骨折受肝肾阴虚证和脾肾两虚证、骨密度、手术椎体个数、骨水泥的渗漏等多种因素影响，临床上要采取针对性的治疗措施，降低再骨折的发生风险。

Abstract: Objective: To investigate the related factors of vertebral re-fracture in patients with osteoporotic vertebral compression fracture (OVCF) after bone cement augmentation treatment from the perspective of traditional Chinese medicine syndrome types. Methods: A retrospective analysis of the patients who underwent Percutaneous Kyphoplasty (PKP) and Percutaneous Vertebroplasty (PVP) in the Department of Orthopedics, Hubei Provincial Hospital of Integrated Traditional Chinese and Western Medicine from 2020-01 to 2022-10 was performed. According to the occurrence of postoperative vertebral re-fracture, the patients were divided into re-fracture group (39 cases) and non-re-fracture group (218 cases). The clinical data of the two groups were collected, and the independent related factors of postoperative vertebral re-fracture were determined by univariate analysis and multivariate logistic regression analysis. Results: There was no significant difference in gender, age, body mass index, fracture history, and surgical site between the two groups (P > 0.05). There were significant differences between the two groups in TCM syndrome type, bone mineral density, the number of initial fractured vertebrae, and bone cement leakage (P < 0.05). There was no significant difference in kidney Yang deficiency syndrome between the two groups (P > 0.05). The proportion of liver and kidney Yin deficiency syndrome, spleen and kidney deficiency syndrome in the re-fracture group was higher, and the proportion of qi stagnation and blood stasis syndrome was lower, the differences were statistically significant (P < 0.05). Multivariate Logistic regression analysis showed that Yin deficiency of liver and kidney, spleen and kidney deficiency, bone mineral density, the number of initial fractured vertebrae, and bone cement leakage were independent related factors for vertebral refracture after bone cement augmentation therapy in OVCF patients(OR > 1, P < 0.05). Conclusion: Vertebral re-fracture after bone cement augmentation therapy in OVCF patients is affected by many factors, such as liver-kidney Yin deficiency syndrome, spleen-kidney deficiency syndrome, bone mineral density, the number of surgical vertebrae, and bone cement leakage.