椎体强化术后早期与后期残留腰背痛的原因分析  

Analysis of the causes of residual back pain in the early and late stages after percutaneous vertebral augmentation

作　　者：陈晨 安忠诚 吴连国 庞哲栋 肖连根 魏浩 董黎强 CHEN Chen;AN Zhong-cheng;WU Lian-guo;PANG Zhe-dong;XIAO Lian-gen;WEI Hao;DONG Li-qian(不详;Department of Traumatology and Orthopaedics,the Second Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou 310005,Zhejiang,China)

机构地区：[1]浙江中医药大学第二临床医学院,浙江杭州310053 [2]浙江中医药大学附属第二医院骨伤科,浙江杭州310005

出　　处：《中国骨伤》2022年第8期724-731,共8页China Journal of Orthopaedics and Traumatology

基　　金：浙江省中医药现代化专项项目(编号:2021ZX009);国家中医临床研究基地支撑学科建设计划(编号:2020-JDXK-ZC01)。

摘　　要：目的:探讨骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCFs)在经皮椎体强化(percutaneous vertebral augmentation,PVA)术后早期和后期残留腰背痛的影响因素,并对这些因素的相关性进行分析。方法:收集2018年3月至2019年12月住院行PVA治疗的312例OVCFs患者,根据病例选择标准,共纳入240例患者的临床资料进行回顾性研究,其中男59例,女181例,年龄50~95(76.11±10.72)岁,骨折节段分布在胸椎区(T-T)50例,胸腰椎区(T-L)159例,腰椎区(L3及以下)31例。将术后第1天视为术后早期,术后第7天视为术后后期,再结合患者的视觉模拟评分(visual analogue scale,VAS)将患者分为术后早期疼痛缓解明显组(A组,VAS评分≤4),共有患者121例,其中男29例,女92例,年龄50~90(75.71±11.00)岁;术后早期疼痛缓解不明显组(B组,VAS评分>4),共有患者119例,男30例,女89例,年龄53~95(76.51±10.46)岁;术后后期疼痛缓解明显组(C组,VAS评分≤4),共有患者172例,男42例,女130例,年龄50~95(76.20±10.68)岁;术后后期疼痛缓解不明显组(D组,VAS评分>4),共有患者68例,男17例,女51例,年龄53~94(75.88±10.91)岁。统计4组患者的年龄、性别、骨密度、伤椎节段、术前胸腰椎筋膜损伤情况、术式选择、术中单双侧穿刺情况、骨水泥注入量、椎体前缘高度及中央高度恢复情况,并对这些因素进行单因素分析,将其中有统计学意义的因素代入Logistic回归模型中,分析它们与PVA术后残留腰背痛的相关性。结果:单因素分析结果示,PVA术后早期残留腰背痛与骨密度、术前胸腰椎筋膜损伤情况、单双侧穿刺情况、骨水泥注入量、椎体前缘高度及中央高度恢复情况相关(P<0.05);术后后期残留腰背痛与骨密度、伤椎节段、术式选择、骨水泥注入量、椎体前缘高度及中央高度恢复情况相关(P<0.05)。多因素Logistic回归分析结果示,在术后早期,合并胸腰椎筋膜损伤情况(OR=4.938,P=0Objective:To explore the influencing factors of the residual back pain in patient with osteoporotic vertebral compression fractures(OVCFs)in the early and late stages after percutaneous vertebral augmentation(PVA),and analyze the correlation between these factors and the residual back pain after PVA.Methods:From March 2018 to December 2019,312 patients with OVCFs who treated with PVA were collected.According to the inclusion and exclusion criteria,a total of 240 patients were included in this retrospective study.There were 59 males and 181 females,aged from 50 to 95 years old with an average of(76.11±10.72)years old,and 50 cases of fractures located in the thoracic region(T-T),159 cases in the thoracolumbar region(T11-L),and 31 cases in the lumbar region(L3 and below).The first day after PVA was regarded as the early postoperative period,and the seventh day was regarded as the late postoperative period.According to the visual analogue scale(VAS),the patients were divided into 4 groups:early postoperative pain relief group(group A,VAS≤4 scores),there were 121 patients,including 29 males and 92 females,aged from 50 to 90 years with an average of(75.71±11.00)years;early postoperative pain relief was not an obvious group(group B,VAS>4 scores),there were 119 patients,including 30 males and 89 females,aged from 53 to 95 years with an average of(76.51±10.46)years;late postoperative pain relief group(group C,VAS≤4 scores),there were 172 patients,including 42 males and 130 females,aged from 50 to 95 years with an average of(76.20±10.68)years;late postoperative pain relief was not obvious group(group D,VAS>4 scores),there were 68 patients,including17 males and 51 females,aged from 53 to 94 years old with an average of(75.88±10.91)years old.The age,gender,bone mineral density(BMD),injured vertebral segment,preoperative thoracolumbar fascial condition,surgical methods,single or bilateral puncture,the amount of bone cement injection,anterior vertebral height recovery rate and central vertebral height recovery rate in

关 键 词：骨质疏松 椎体成形术 脊柱骨折 腰背痛 手术后并发症 

分 类 号：R683.2[医药卫生—骨科学]