ANVCFV评分系统：对于椎体压缩骨折病人行经皮椎体成形术后其他椎体再骨折的风险因素评估

发布时间：2018-06-05 02:34

本文选题：椎体压缩骨折 + 经皮椎体成形术　；参考：《东南大学》2015年硕士论文

【摘要】：目的探寻椎体压缩骨折病人行经皮椎体成形术后其他椎体再骨折的风险因素及建立评价再骨折风险的评分系统。方法我们入组了从2007年1月至2013年12月分别在A医院(实验组)及B医院(验证组)行第一次PVP手术的椎体压缩骨折病人。在实验组中,我们依次通过单因素分析、C检验及多因素Cox回归分析得出PVP术后病人再骨折的独立风险因素,然后通过多因素Cox回归模型建立评价再骨折风险的评分系统(ANVCFV: assessment for new vertebral compression fractures after percutaneous vertebroplasty)结果共有397位病人入组(实验组：n=241；验证组：n=156)。在实验组中,我们得出PVP术后病人再骨折的独立风险因素为：较低的CT值、陈旧性骨折的存在、骨水泥渗漏至椎间盘、一次治疗椎体节数大于一节、骨水泥分布于椎体上方或下方,随后我们基于这五个独立风险因素建立了ANVCFV评分系统。通过Kaplan-Meier生存曲线的结果我们根据判别再骨折概率的高低将病人分为两组：ANVCFV分数不大于8.5分的个体及ANVCFV分数大于8.5分的个体。这两组病人间未再骨折时间存在最大差异(1846 vs.732天,P0.001)。ANVCFV分数不大于8.5分的病人再骨折的概率很低,ANVCFV分数大于8.5分的病人再骨折的概率很高。该系统在实验组中的准确性为77.4%,在验证组中的准确性为85.3%。结论椎体压缩骨折病人行第一次PVP手术后若ANVCFV得分大于8.5分则有很大可能发生其他椎体的再骨折。
[Abstract]:Objective to explore the risk factors of other vertebral refracture after percutaneous vertebroplasty in patients with vertebral compression fracture and to establish a scoring system to evaluate the risk of refracture. Methods from January 2007 to December 2013, we performed the first PVP operation in Hospital A (experimental group) and B hospital (validation group). In the experimental group, the independent risk factors for refracture were obtained by univariate analysis and multivariate Cox regression analysis. Then, a multivariate Cox regression model was used to establish a scoring system for evaluating the risk of refracture. Assessment for new vertebral compression fractures after percutaneous vertebroplasty) results showed that 397 patients were enrolled in the study group (experimental group: n = 241; validation group: n = 156). In the experimental group, we found that the independent risk factors for refracture after PVP were: lower CT value, the presence of old fractures, the leakage of bone cement to the intervertebral disc, the number of vertebra segments more than one at a time. Bone cement was distributed above or below the vertebral body, and then we established an ANV CFV scoring system based on these five independent risk factors. According to the results of Kaplan-Meier survival curve, patients were divided into two groups according to the probability of refracture. There was the greatest difference between the two groups in the time of non-refracture. The probability of refracture was very low in patients with a score of 1846 vs.732 / d. ANV CFV score less than 8.5. The probability of refracture in patients with ANV CFV score greater than 8.5 was very high. The accuracy of the system was 77.4 in the experimental group and 85.3 in the validation group. Conclusion if the score of ANV CFV is higher than 8.5 after the first PVP operation, refracture of other vertebral bodies may occur in patients with compression fracture of vertebral body.
【学位授予单位】：东南大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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