The Incidence And Related Risk Factors Of Refracture After Vertebroplasty In The Elderly Aged 80 Years And Above

Background:In recent years,percutaneous vertebroplasty and percutaneous kyphoplasty have been widely used in the clinical treatment of vertebral compression fractures due to their characteristics of stabilizing the affected vertebrae,relieving pain,and improving the degree of vertebral compression.However,with the deepening of clinical research,reports on re-fractures after vertebroplasty are also endless.Re-fractures after vertebroplasty include surgery,re-fractures of adjacent and distant segments,no matter what form of re-fractures,will cause a serious burden on patients and society.Therefore,the understanding of the incidence of re-fracture after vertebroplasty and its risk factors also need new breakthroughs and progress.In previous studies,the clinical data of all patients with re-fractures after a period of time in the institution were collected for analysis,so as to speculate the mechanism and related risk factors of re-fractures.However,the age span of the population counted in this way is large,and the data deviation caused by the age span is greater.Although its statistical results can provide reference for treatment,it cannot provide targeted treatment experience.Not only that,China has a large number of elderly people,and the elderly population is different from the general population in terms of their own conditions,social conditions,morbidity,and treatment process.More targeted treatment and research are needed.Objective:By discussing the risk factors of recurring fractures in the surgical segment and adjacent segments after vertebroplasty in the elderly aged ?80 years old,the clinical results deviations caused by the large age span are reduced to make the research results more accurate and targeted.At the same time,summarize the morbidity and characteristics of the elderly in the region,and explore specific treatment plans in the region,with a viewto reducing the incidence of postoperative re-bone fractures in elderly patients and improving the quality of life of elderly patients in the region.Methods:A retrospective analysis of the data of all patients treated with PVP from January2016 to December 2018 in our department.According to the relevant enrollment criteria,collect relevant follow-up data before and after the operation of the patient,and the age,gender,body mass index,fractured vertebral body location,presence or absence of vertebral body fissure signs,osteoporosis severity,bone cement material characteristics,surgical approach,distribution pattern factors of bone cement(bone cement dosage and its relationship with end plate,bone cement coagulation morphology and its specific distribution,whether leakage occurs),height change of anterior vertebral margin before and after surgery.The changes of sagittal angle of the vertebrae before and after the operation,whether there are related treatments to prevent osteoporosis,whether there is hypertension,whether or not suffering from diabetes,and the history of fractures in other parts were analyzed retrospectively.According to the diagnostic criteria of surgery and re-fracture of the adjacent vertebral body,the included subjects were divided into non-re-fracture group and re-fracture group after treatment,and related risk factors were studied and analyzed based on single factor and multi-factor analysis.Results:The results of the study showed that after vertebral body treatment for 276 fractured vertebral bodies,a total of 55 cases(19.93%)had vertebral body fractures.Among them,the incidence of re-fractures in adjacent segments accounted for 11.23% of all surgical segments,and the incidence of re-fractures in surgical segments accounted for 4.71% of all surgical segments.Comparison between the re-fracture group near the segment and the group without re-fracture: the results of univariate analysis suggest the patient's age,bone cement dosage,bone cement distribution,preoperative vertebral edge height ratio,and postoperative vertebral body leading edge improvement percentage comparison between the two groups there was a correlation(P <0.05).Multivariate logistic analysis suggested that age,bone cement distribution,and percentage of postoperative vertebral body anterior margin improvement were the main risk factors for re-fracture of the adjacent segment after treatment.Fracture group comparison: after a single factor analysis,the patient's age,vertebral fissure sign,bone cement dosage,bone cement distribution and morphology were correlated between the two groups(P <0.05),and multivariate logistic analysisindicated the patient's age and bone cement Dose and bone cement distribution are the main risk factors for vertebral re-fracture after treatment.Conclusion:(1)The age of the patient,the height of the improved vertebral anterior edge after treatment,and the distribution of bone cement are risk factors for the fracture of the adjacent segment after vertebroplasty treatment for elderly patients ?80 years old.The elderly population has different morbidity characteristics from previous studies in the treatment process,so we should avoid excessive reduction of the anterior edge of the compressed vertebral body and pay attention to make the bone cement evenly distributed on both sides.(2)Older age,bone cement dosage and distribution are risk factors for re-fracture of surgical segments after vertebroplasty in elderly patients ?80 years old.So during the operation,attention should be paid to control the dosage of bone cement injection,and as far as possible,the bone cement should be filled evenly and bilaterally in order to reduce the incidence of re-fracture in the surgical segment after treatment.