合并终板骨折的老年骨质疏松椎体压缩性骨折患者球囊椎体后凸成形术的疗效分析  

Analysis of osteoporotic vertebral compression fracture with endplate fracture on the outcome of balloon kyphoplasty in elderly

作　　者：张建伟 薛有地[1] 王春增 马超[1] 刘光普[1] Zhang Jianwei;Xue Youdi;Wang Chunzeng;Ma Chao;Liu Guangpu(Department of Spinal Surgery,Xuzhou Central Hospital,Xuzhou 221009,China)

机构地区：[1]徐州市中心医院脊柱外科,徐州221009

出　　处：《中华解剖与临床杂志》2024年第12期823-829,共7页Chinese Journal of Anatomy and Clinics

基　　金：徐州市科技计划(KC21206);江苏省卫生健康委科研项目(Z2022040)。

摘　　要：目的探讨老年人骨质疏松性椎体压缩性骨折(OVCF)合并终板骨折的球囊椎体后凸成形术(BKP)疗效。方法回顾性队列研究。纳入2016年6月—2021年6月徐州市中心医院行BKP治疗的单节段OVCF患者371例,其中男79例、女292例,年龄60~86(71.8±6.7)岁。根据患者终板骨折情况,分为终板正常组(EP1组)139例、上终板骨折组(EP2组)145例、下终板骨折组(EP3组)35例和上下终板骨折组(EP4组)52例。观察指标:(1)比较4组患者年龄、性别、体质量指数、受伤至手术时间、受伤椎体节段、骨密度及合并症等基线资料;(2)比较4组患者手术时间、骨水泥注入量、术中骨水泥椎间盘渗漏情况,以及术后切口感染、脊髓神经损伤、肺栓塞等手术相关并发症发生情况;(3)比较4组患者术前和术后第1天、术后1年的疼痛视觉模拟评分法(VAS)评分、Oswestry功能障碍指数(ODI)、Cobb角、椎体前缘高度(AVH),以及术后1年骨密度变化、邻近椎体骨折、椎体高度再丢失的发生情况。结果(1)4组患者基线资料比较差异均无统计学意义(P值均>0.05)。(2)371例患者均顺利完成BKP手术。4组手术时间、骨水泥注入量比较,差异均无统计学意义(P值均>0.05)。术中骨水泥椎间盘渗漏发生率EP1组4.3%(6/139)、EP2组24.8%(36/145)、EP3组22.9%(8/35)、EP4组38.5%(20/52),4组间比较差异有统计学意义(χ^(2)=36.00,P<0.001)。4组患者均无切口感染、脊髓神经损伤、肺栓塞等并发症发生。(3)371例患者均获随访1年。组内比较:与术前比较,4组患者术后第1天和术后1年VAS评分、ODI、Cobb角均减少,AVH均增大,差异均有统计学意义(P值均<0.001)。与术后第1天比较,EP1组术后1年VAS评分、ODI均减少,差异均有统计学意义(P值均<0.001),而术后1年Cobb角、AVH差异均无统计学意义(P值均>0.05);EP2组、EP3组及EP4组术后1年VAS评分、ODI及AVH均减小,Cobb角均增大,差异均有统计学意义(P值均<0.001)。组�Objective This study aimed to investigate the effects of osteoporotic vertebral compression fracture(OVCF)with endplate fracture on the outcome of ballon kyphoplasty(BKP)in the elderly.Methods A retrospective cohort study was conducted.A total of 371 patients with single-segment OVCF in Xuzhou Central Hospital from June 2016 to June 2021 were included,including 79 males and 292 females,with an average age of(71.8±6.7)years(range,60-86 years).All patients underwent BKP,and they were divided into normal endplate group(EP1),superior endplate fracture group(EP2),inferior endplate fracture group(EP3),and superior and inferior endplate fracture group(EP4)on the basis of endplate fracture by preoperative MRI examination.The following observation indices were investigated:(1)The age,gender,time from injury to operation,body mass index,injured vertebral segment,bone mineral density,and comorbidities of the four groups were compared.(2)The operation time;volume of bone cement injected;bone cement intradiscal leakage;and complications,such as postoperative incision infection,spinal cord nerve injury,and pulmonary embolism,among the four groups were compared.(3)The visual analogue scale(VAS)scores,Oswestry disability index(ODI),Cobb angle,and anterior vertebral height(AVH)of the four groups were compared 1 day and 1 year after surgery.The bone mineral density,adjacent vertebral fracture,and vertebral height loss at postoperative 1 year among the four groups were compared.Results(1)No statistically significant difference in baseline data was observed among the four groups(all P values>0.05).(2)The operation was successfully performed in all the 371 patients.Among them,6 patients were bone cement intradiscal leakage in the EP1 group(4.3%,6/139),36 patients in the EP2 group(24.8%,36/145),8 patients in the EP3 group(22.9%,8/35),and 20 patients in the EP4 group(38.5%,20/52).A statistically significant difference was found in the incidence of bone cement leakage among the four groups(χ^(2)=36.00,P<0.001).All patients had no comp

关 键 词：脊柱骨折 骨折 压缩性 终板骨折 骨质疏松 老年人 胸椎 腰椎 球囊椎体后凸成形术 

分 类 号：R687.3[医药卫生—骨科学]