急性症状性骨质疏松性胸腰椎压缩骨折椎体强化手术后疗效欠佳:与骨水泥、骨密度、邻近骨折的关系  

Poor efficacy after vertebral augmentation surgery of acute symptomatic thoracolumbar osteoporotic compression fracture:relationship with bone cement,bone mineral density,and adjacent fractures

作　　者：刘畅[1] 李大同 刘元 孔令擘 郭瑞 杨利学[1] 郝定均[3] 贺宝荣[3] Liu Chang;Li Datong;Liu Yuan;Kong Lingbo;Guo Rui;Yang Lixue;Hao Dingjun;He Baorong(Shaanxi University of Chinese Medicine,Xianyang 712046,Shaanxi Province,China;Medical School of Yan’an University,Yan’an 716000,Shaanxi Province,China;Honghui Hospital,Xi’an Jiaotong University,Xi’an 710054,Shaanxi Province,China;Shiyan Hospital of Integrated Traditional and Western Medicine,Shiyan 442000,Hubei Province,China)

机构地区：[1]陕西中医药大学,陕西省咸阳市712046 [2]延安大学医学院,陕西省延安市716000 [3]西安交通大学附属红会医院,陕西省西安市710054 [4]十堰市中西医结合医院,湖北省十堰市442000

出　　处：《中国组织工程研究》2021年第22期3510-3516,共7页Chinese Journal of Tissue Engineering Research

基　　金：陕西省科技厅科技成果转移与推广计划-获奖成果转化项目(2018HJCG-08),项目负责人:贺宝荣,项目名称:脊柱损伤修复关键技术的推广应用。

摘　　要：背景:近年来应用椎体强化治疗骨质疏松性椎体骨折具有较好的疗效,但随着病例数的不断增加,临床工作中发现部分患者在接受椎体强化术治疗后仍诉有明显的疼痛。目的:分析影响急性症状性骨质疏松性胸腰椎骨折行椎体强化术后疗效欠佳的多重因素,并进行相关因素的多因素Logistic回归分析。方法:纳入2016年7月至2019年5月西安交通大学附属红会医院收治的骨质疏松性胸腰椎骨折患者850例,均为初次接受椎体强化治疗,依据术后1个月内腰背部疼痛目测类比评分判定疗效情况,其中≥4分为疗效欠佳,共61例患者疗效欠佳(疗效欠佳组);采用随机数字表法从789例疗效满意的患者中选择61例作为疗效满意组。调查两组性别、年龄、体质量指数、术前骨密度T值、手术节段、手术时间、手术路径、骨折压缩程度、注入骨水泥的量、术后骨水泥是否渗漏、骨水泥渗漏类型、术后邻近节段骨折、软组织损伤、术后骨水泥分布等资料,采用单因素及多因素Logistic回归分析探讨患者术后疗效欠佳的危险因素。研究获西安交通大学附属红会医院医学伦理委员会批准(编号:202005005)。结果与结论:①两组间年龄、性别、手术时间、手术路径、骨折压缩程度、手术节段比较差异无显著性意义(P>0.05),骨水泥渗漏、邻近节段骨折、软组织损伤、骨水泥分布、骨密度T值、骨水泥注入量比较差异均有显著性意义(P<0.05);②二元Logistic回归分析显示,椎体强化后疗效欠佳与骨水泥渗漏、邻近节段骨折、软组织损伤、骨水泥分布、骨密度T值有显著相关性(P<0.05);③ROC分析显示,骨密度T值预测患者行椎体强化术后疗效欠佳的AUC为0.809(β=0.040,95%CI=0.729-0.888,P=0.000),最佳截断值为-3.05,敏感度和特异度分别为0.721和0.836;④结果说明,骨水泥分布、骨水泥渗漏、邻近节段骨折、软组织损伤、骨密度T值是BACKGROUND:In recent years,vertebral augmentation surgery has a good effect on osteoporotic vertebral fracture,but with the increasing number of cases,we have found that some patients still complain of obvious pain after receiving vertebral augmentation surgery.OBJECTIVE:To analyze the multiple factors that affect the poor efficacy after vertebral augmentation surgery of acute symptomatic thoracolumbar osteoporotic compression fracture,and to conduct a multivariate logistic regression analysis of related factors.METHODS:The data of 850 patients who were treated with primary vertebral augmentation in the treatment of vertebral compression fractures in Honghui Hospital,Xi’an Jiaotong University from July 2016 to May 2019 were retrospectively analyzed.According to the visual analogue scale score of low back pain within one month after operation,the curative effect was judged by the score,in which≥4 points were regarded as poor curative effect.A total of 61 patients had poor curative effect(poor curative effect group).The random number table method was used to select 61 patients from 789 patients with satisfactory curative effect as the satisfactory group.The gender,age,body mass index,preoperative bone mineral density T value,operative segment,operation time,surgical path,degree of fracture compression,bone cement injection volume,postoperative bone cement leakage,type of bone cement leakage,postoperative adjacent segment fracture,soft tissue injury,and postoperative bone cement distribution were investigated in both groups.Univariate and multivariate logistic regression analysis was used to explore the risk factors of poor efficacy.This study was approved by the Ethics Committee of Honghui Hospital,Xi’an Jiaotong University(approval No.202005005).RESULTS AND CONCLUSION:(1)There was no significant difference between the two groups of patients in terms of age,gender,operation time,surgical path,the degree of compression fracture,and injured vertebral segment(P>0.05).There were statistically significant differen

关 键 词：骨 材料 骨水泥 椎体强化 骨质疏松 椎体骨折 术后疼痛 危险因素 组织工程 

分 类 号：R459.9[医药卫生—治疗学] R683.2[医药卫生—临床医学]