骨质疏松性椎体压缩骨折椎体强化术后残余腰背痛的影响因素分析  

Factors influencing residual low back pain after vertebral augmentation for treatment of osteoporotic vertebral compression fracture

作　　者：张会 鄢卫平[2] 刘卫义 郭广宇 李佳坤 段文帅 毛建伟 ZHANG Hui;YAN Weiping;LIU Weiyi;GUO Guangyu;LI Jiakun;DUAN Wenshuai;MAO Jianwei(Gansu University of Chinese Medicine,Lanzhou 730000,Gansu,China;Gansu Provincial Hospital of TCM,Lanzhou 730050,Gansu,China)

机构地区：[1]甘肃中医药大学,甘肃兰州730000 [2]甘肃省中医院,甘肃兰州730050

出　　处：《中医正骨》2024年第8期31-34,共4页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:分析骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)椎体强化术后残余腰背痛的影响因素。方法:回顾性分析采用椎体强化手术治疗的OVCF患者的病例资料,提取性别、年龄、体质量、是否合并糖尿病、是否合并高血压、是否有脊柱外伤史、是否合并Kümmell病、手术方式、骨水泥注入量、骨水泥分布情况、是否合并术后椎体感染、术前和术后1年椎体高度压缩比、术前和术后1年椎体后凸Cobb角及术后1年是否残余腰背痛等信息。根据术后1年患者是否残余腰背痛,将纳入研究的患者分为术后残余腰背痛组和术后无残余腰背痛组。先对2组患者的相关信息进行单因素分析,再采用多因素Logistic回归分析OVCF椎体强化术后残余腰背痛的影响因素。结果:共纳入602例OVCF患者,其中术后残余腰背痛组患者52例、术后无残余腰背痛组550例。2组患者是否有脊柱外伤史、是否合并Kümmell病、骨水泥注入量、骨水泥分布情况、术后1年椎体高度压缩比、术后1年椎体后凸Cobb角比较,组间差异均有统计学意义[χ^(2)=16.062,P=0.000;χ^(2)=6.453,P=0.011;(3.65±0.70)mL,(4.25±0.94)mL,t=-2.249,P=0.031;χ^(2)=12.366,P=0.000;(30.93±3.97)%,(23.21±4.02)%,t=6.917,P=0.000;12.41°±3.69°,6.82°±2.63°,t=0.065,P=0.000]。Logistic回归分析结果显示,合并Kümmell病、骨水泥分布不理想、术后1年椎体高度压缩比偏大、术后1年椎体后凸Cobb角偏大是OVCF椎体强化术后1年仍残余腰背痛的危险因素(β=1.682,P=0.031,OR=0.153;β=0.893,P=0.047,OR=2.202;β=0.635,P=0.014,OR=0.359;β=0.721,P=0.040,OR=0.762)。结论:合并Kümmell病、骨水泥分布不理想、术后椎体高度和椎体后凸畸形矫正不佳是OVCF椎体强化术后残余腰背痛的危险因素。Objective:To analyze the factors influencing residual low back pain(LBP)after vertebral augmentation for treatment of osteoporotic vertebral compression fracture(OVCF).Methods:The medical records of patients who underwent vertebral augmentation for treatment of OVCF were retrospectively analyzed.The information of the enrolled patients,including gender,age,body mass,whether combined with diabetes mellitus,hypertension,Kümmell’s disease,and postoperative vertebral infection,spinal trauma history,operation me-thod,consumption and distribution of bone cement,preoperative and postoperative year-1 vertebral height compression ratio and kyphosis Cobb’s angle,as well as whether presence of residual LBP at postoperative year-1,was extracted from the Electronic Medical Record System(EMRS).The included patients were divided into postoperative residual LBP group and postoperative non-residual LBP group based on whether the residual LBP was found at postoperative year-1.The single-factor analysis was conducted on the extracted information for screening the factors affecting residual LBP,followed by multi-factor logistic regression analysis on the screened factors for identifying the factors influencing residual LBP after vertebral augmentation for OVCF.Results:Six hundred and two patients were enrolled in the study,52 ones in postoperative residual LBP group and 550 ones in postoperative non-residual LBP group.The differences were statistically significant between the 2 groups in spinal trauma history,whether combined with Kümmell’s disease,consumption of bone cement,distribution of bone cement,postoperative year-1 vertebral height compression ratio and kyphosis Cobb’s angle(χ^(2)=16.062,P=0.000;χ^(2)=6.453,P=0.011;3.65±0.70 vs 4.25±0.94 mL,t=-2.249,P=0.031;χ^(2)=12.366,P=0.000;30.93±3.97 vs 23.21±4.02%,t=6.917,P=0.000;12.41±3.69 vs 6.82±2.63 degrees,t=0.065,P=0.000).The results of multi-factor logistic regression analysis showed that combined Kümmell’s disease,suboptimal bone cement distribution,a grea

关 键 词：腰痛 背痛 骨质疏松性骨折 脊柱骨折 骨折 压缩性 椎体成形术 后凸成型术 

分 类 号：R687.3[医药卫生—骨科学]