摘要目的:探讨胸腰椎骨折行切开复位后路椎弓根螺钉内固定术后，形成"蛋壳样椎体"的危险因素。方法:回顾性分析2020年1月至2023年1月苏州大学附属第一医院收治的118例胸腰椎单节段骨折患者资料，将患者根据后路椎弓根螺钉内固定术后伤椎是否形成"蛋壳样椎体"分为病例组（47例）和对照组（71例）。比较两组患者的性别、年龄、随访时间、体重指数、原发性高血压病史、糖尿病病史、椎体骨质量（VBQ）评分、局部Cobb角纠正、伤椎是否置钉、骨折部位、骨折类型、后方韧带复合体是否损伤、伤椎上下椎间盘及终板是否损伤、伤椎前缘、中间、后缘高度恢复率，术前、术后疼痛视觉模拟评分（VAS）。通过单因素分析筛选阳性指标（ P<0.05），将阳性指标纳入多因素logistic回归模型和受试者操作特征(ROC)曲线分析，分析胸腰椎骨折行后路钉棒内固定术后形成"蛋壳样椎体"的危险因素。 结果:118例患者中共47例术后出现"蛋壳样椎体"，单因素分析显示：VBQ评分、伤椎是否置钉、骨折类型为爆裂性骨折、后方韧带复合体损伤、伤椎上下椎间盘/终板损伤、伤椎前缘高度恢复率、伤椎中间高度恢复率两组患者间比较差异均有统计学意义（ P<0.05）。多因素logistic回归分析及ROC曲线分析结果显示，VBQ评分≥2.95分（ OR=6.216, 95% CI: 1.890~20.441， P=0.003）、伤椎前缘高度恢复率≥25.26%（ OR=1.097, 95% CI: 1.046~1.149, P<0.001）、骨折类型为爆裂性骨折（ OR=6.397, 95% CI: 1.733~23.617, P=0.005）、椎间盘/终板复合体损伤（ OR=7.581, 95% CI: 1.827~31.461, P=0.005）与胸腰椎骨折行后路钉棒内固定术后形成"蛋壳样椎体"显著相关（ P < 0.05）。 结论:VBQ评分≥2.95分、伤椎前缘高度恢复率≥25.26%、爆裂性骨折、椎间盘/终板复合体损伤是导致胸腰椎骨折行后路椎弓根螺钉内固定术后形成"蛋壳样椎体"改变的危险因素。

abstractsObjective:To investigate the risk factors for the formation of eggshell vertebral body after open reduction and internal fixation with posterior screw-rod system for thoracolumbar spine fractures. Methods:A retrospective study was conducted to analyze the 118 patients with thoracolumbar single-segment fracture who had been treated at Department of Orthopaedic Surgery, The First Hospital Affiliated to Soochow University between January 2020 and January 2023. The patients were divided into a case group (47 cases) and a control group (71 cases) according to whether an eggshell vertebral body developed in the injured vertebra after internal fixation with posterior screw-rod system. The 2 groups were compared in terms of gender, age, follow-up time, body mass index, history of primary hypertension, history of diabetes mellitus, vertebral bone quality (VBQ) score, local Cobb angle correction, presence or absence of screwing at the injured vertebra, fracture site, fracture type, presence or absence of injury to the posterior ligamentous complex, presence or absence of injury to the upper and lower discs/endplate complex in the injured vertebrae, recovery rates of the anterior, middle, and posterior heights of the injured vertebra, and preoperative and postoperative visual analog scale (VAS) for pain. After positive indicators were screened by univariate analysis ( P<0.05), they were included in a multivariate logistic regression model and receiver operating characteristic curve (ROC) to analyze the risk factors for the formation of eggshell vertebral body after posterior screw-rod internal fixation of thoracolumbar spine fractures. Results:Of the 118 patients, 47 developed an eggshell vertebral body after surgery. Univariate analysis showed that VBQ score, presence or absence of screwing at the injured vertebra, burst fracture type, injury to the posterior ligamentous complex, injury to the upper and lower discs/endplate complex in the injured vertebrae, recovery rate of the anterior height of the injured vertebra, recovery rate of the middle height of the injured vertebra were statistically significant ( P<0.05). The multivariate logistic regression analysis and ROC curve analysis showed that a VBQ score ≥ 2.95 points( OR=6.216, 95% CI: 1.890 to 20.441, P=0.003), a recovery rate of the anterior height of the injured vertebra ≥ 25.26% ( OR=1.097, 95% CI: 1.046 to 1.149, P<0.001), a burst fracture type ( OR=6.397, 95% CI: 1.733 to 23.617, P=0.005), and injury to the upper and lower discs/endplate complex in the injured vertebrae ( OR=7.581, 95% CI: 1.827 to 31.461, P=0.005) were significantly associated with the formation of eggshell vertebral body after open reduction and internal fixation with posterior screw-rod system for thoracolumbar spine fractures ( P<0.05). Conclusion:A VBQ score ≥ 2.95 points, a recovery rate of the anterior height of the injured vertebra ≥ 25.26%, a burst fracture type, and injury to the disc/endplate complex in the injured vertebrae are the independent risk factors for the formation of eggshell vertebral body after open reduction and internal fixation with posterior screw-rod system for thoracolumbar spine fractures.