糖尿病合并骨质疏松性胸腰椎压缩骨折经皮球囊扩张椎体后凸成形术的疗效分析  

Therapeutic effect and prognosis of PKP in patients with diabetes mellitus complicated with osteoporotic thoracolumbar compression fractures

作　　者：陶利江 郑杰 孙忠良 楼肃亮 卢一生 Tao Lijiang;Zheng Jie;Sun Zhongliang;Lou Suliang;Lu Yisheng(Department of Orthopedic Surgery,903rd Hospital of PLA,Hangzhou 310012,China)

机构地区：[1]解放军联勤保障部队第九〇三医院骨科,杭州310012

出　　处：《中华内分泌外科杂志》2023年第2期198-203,共6页Chinese Journal of Endocrine Surgery

基　　金：国家重点基础研究发展计划(973计划)(2013CB532002)。

摘　　要：目的探讨糖尿病合并骨质疏松性胸腰椎压缩骨折经皮球囊扩张椎体后凸成形术(percutaneous balloon kyphoplasty,PKP)的治疗效果及对预后影响。方法选取2017年5月至2020年2月于解放军联勤保障部队第九〇三医院接受诊治,且随访至2022年3月的105例糖尿病合并骨质疏松性胸腰椎压缩骨折患者作为研究对象,均予以PKP术治疗,观察疗效、手术时间、术中出血量、住院时间、继发性椎体骨折发生率、伤椎前缘高度、矢状位后凸Cobb角、VAS评分、ODI指数。且根据随访期间患者有无继发性椎体骨折分为预后良好组(82例)与预后不良组(23例),采用二元Logistic回归模型分析影响预后的危险因素。结果105例患者均予以PKP术治疗后优良率为87.62%、继发性椎体骨折发生率21.90%;手术时间(83.52±16.85)min、术中出血量(32.11±1.52)mL、住院时间(10.62±1.65)d。术后3个月、末次随访时的伤椎前缘高度分别为(24.62±5.16)mm、(24.67±5.03)mm,高于术前(t=15.21、15.63,P均=0.000),术后3个月、末次随访时的矢状位后凸Cobb角分别为(10.03±1.27)°、(10.10±1.25)°,VAS评分分别为(3.11±0.52)分、(1.00±0.11)分,ODI指数分别为(11.25±2.85)%、(5.32±1.01)%,低于术前(t术后3个月=28.84、18.17、29.21,t末次随访=25.68、27.49、42.78,P均=0.000)。预后良好组与预后不良组在年龄、BMD、骨水泥渗漏、骨水泥分布、使用抗骨质疏松药等资料比较中,差异有统计学意义(t=4.03、5.22,χ^(2)=12.50、22.694、26.22,P均=0.000)。Logistic回归分析显示,年龄(OR=1.309,95%CI=1.134~1.511,P=0.000)、BMD(OR=126.660,95%CI=13.376~1199.376,P=0.000)、骨水泥渗漏(OR=4.698,95%CI=1.306~16.902,P=0.018)、骨水泥致密型分布(OR=9.697,95%CI=2.679~34.869,P=0.001)、未使用抗骨质疏松药(OR=7.586,95%CI=2.197~26.193,P=0.001)是影响糖尿病合并骨质疏松性胸腰椎压缩骨折患者预后的独立危险因素。结论PKP治疗糖尿病合并骨质疏松性胸腰椎压缩Objective To investigate the therapeutic effect and prognosis of percutaneous balloon kyphoplasty(PKP)for diabetic patients with osteoporotic thoracolumbar compression fractures.Methods A total of 105 patients with diabetes mellitus complicated with osteoporotic thoracolumbar compression fractures who received diagnosis and treatment in our hospital from May.2017 to Feb.2020,who were followed up to Mar.2022 were selected as the research subjects,and all were treated with PKP.Time,intraoperative blood loss,hospital stay,incidence of secondary vertebral fracture,anterior height of injured vertebral body,Sagittal kyphosis Cobb angle,VAS score,and ODI index were investigated.The patients were divided into good prognosis group(n=82)and poor prognosis group(n=23)according to the presence or absence of secondary vertebral fractures during the follow-up period.Binary Logistic regression model was used to analyze the risk factors affecting the prognosis.Results After PKP treatment,the efficiency of all 105 patients was 87.62%and the incidence of secondary vertebral fracture was 21.90%.The operative time was(83.52±16.85)min,the intraoperative blood loss was(32.11±1.52)ml,and the length of hospital stay was(10.62±1.65)d.The height of the anterior edge of the injured vertebra was(24.62±5.16)mm and(24.67±5.03)mm at the last follow-up and 3 months after surgery,respectively,higher than that before surgery(t=15.21,15.63,P=0.000).The Cobb angle of sagittal kyphosis was(10.03±1.27)°and(10.10±1.25)°,respectively,and the VAS score was(3.11±0.52)and(1.00±0.11)points,respectively,3 months after surgery and at the last follow-up.The ODI indexes were(11.25±2.85)%and(5.32±1.01)%,respectively,lower than those before surgery(t3 months after surgery=28.84,18.17,29.21,tlast follow-up=25.68,27.49,42.78,P=0.000).There were significant differences in age,BMD,bone cement leakage,bone cement distribution and use of anti-osteoporosis drugs between the good prognosis group and the poor prognosis group(t=4.03,5.22,χ^(2)=12.50,22.694,2

关 键 词：糖尿病 骨质疏松 胸腰椎压缩骨折 经皮球囊扩张椎体后凸成形术 

分 类 号：R587.2[医药卫生—内分泌] R687.3[医药卫生—内科学]