PKP治疗骨质疏松性椎体压缩骨折早期疼痛缓解不佳相关因素分析  

PKP Operation in the Treatment of Osteoporotic Vertebral Compression Fractures

作　　者：李元[1] 李立平[1] 李强[1] Li Yuan;Li Liping;Li Qiang(Department of Orthopaedics,Fuxing Hospital,Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属复兴医院骨科,北京100038

出　　处：《实用骨科杂志》2023年第5期390-394,共5页Journal of Practical Orthopaedics

摘　　要：目的探讨经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗老年胸腰椎单椎体骨质疏松性椎体压缩骨折术后早期疼痛缓解不明显的危险因素。方法自2016年12月至2019年12月在首都医科大学附属复兴医院接受PKP手术治疗的60岁以上老年胸腰椎单椎体骨质疏松性椎体压缩骨折患者136例,其中男36例,女100例;年龄60~94岁,平均(81.0±8.1)岁,收集患者年龄、性别、有无外伤史、内科合并症(高血压、糖尿病等)、术前骨密度、骨折椎体位置、骨折压缩程度、手术时间、疼痛视觉模拟评分(visual analogue scale,VAS)、骨水泥注入量、有无骨水泥渗漏、骨水泥分布情况、有无合并筋膜损伤等资料,根据术后早期疼痛缓解是否满意分为疼痛缓解不佳组(VAS>4分)及疼痛缓解满意组(VAS≤4分),对两组上述各因素进行比较。结果单因素分析显示两组在术前骨密度值、骨折压缩程度、骨水泥分布情况及是否合并胸腰筋膜损伤方面比较差异有统计学意义(P<0.05)。多因素Logistic回归分析显示术前骨密度值较低、骨折压缩程度为Ⅲ度(Genant目视半定量法)、骨水泥分布欠佳、合并胸腰筋膜损伤是PKP术后早期疼痛缓解不明显的危险因素。结论PKP是治疗胸腰椎骨质疏松性椎体压缩骨折的有效术式,术后早期疼痛缓解不明显与患者术前骨密度值较低、椎体高度丢失明显、合并胸腰筋膜损伤、术中骨水泥分布欠佳等因素有关。Objective To explore the risk factors related to poor relief of back pain after percutaneous kyphoplasty(PKP)operation in the treatment of osteoporotic vertebral compression fractures.Methods 136 patients aged over 60(36 male,100 female)with osteoporotic vertebral compression fractures(OVCF)were treated by PKP operation from December 2016 to December 2019 in our hospital.The mean age of the patients was(81.0±8.1)years(60~94 years).The data of age,gender,history of trauma,medical comorbidities(hypertension,diabetes),preoperative bone mineral density(BMD),position of fracture vertebral body,vertebral compression degree,operation time,visual analogue scale,volume of cement injection,cement leakage,cement distribution,whether combined with fascia injury of the patients were collected.According to the early postoperative visual analogue scale(VAS),the patients were divided into poor pain relief group(VAS>4)and satisfactory pain relief group(VAS≤4).The data of the two groups were analyzed.Results Univariate analysis showed that there were significant difference between the two groups in preoperative bone mineral density,degree of fracture compression,distribution of cement and whether combined with fascia injury(P<0.05).Multivariate Logistic regression analysis showed that low preoperative bone mineral density,fracture compressionⅢ(Genant semiquantitative),poor cement distribution,and combined with thoracolumbar fascia injury were risk factors for poor relief of back pain after PKP.Conclusion PKP is an effective procedure for the treatment of OVCF.Low preoperative bone mineral density,obvious loss of vertebral body height,combined with thoracolumbar fascia injury,and poor cement distribution are the main factors associated with poor relief of back pain after PKP.

关 键 词：胸腰椎 骨质疏松性椎体压缩骨折 椎体后凸成形术 疼痛 

分 类 号：R683.2[医药卫生—骨科学]