老年椎体压缩性骨折患者椎体成形术后疼痛的影响因素分析  

Analysis of influencing factors of pain after vertebroplasty in elderly patients with vertebral compression fracture

作　　者：苗莎 李芳[1] Miao Sha;Li Fang(Department of Spinal Surgery,Second People's Hospital of Lianyungang City,Lianyungang,Jiangsu,222000,P.R.China)

机构地区：[1]连云港市第二人民医院脊柱外科,江苏连云港222000

出　　处：《老年医学与保健》2024年第6期1754-1758,共5页Geriatrics & Health Care

摘　　要：目的通过分析老年椎体压缩性骨折(VCF)患者椎体成形术后疼痛的相关影响因素,以期为临床干预提供必要参考,改善老年患者预后状况。方法回顾性选择2023年1月—2024年1月在连云港市第二人民医院脊柱外科采用PVP治疗的120老年VCF胸腰段骨折患者,应用视觉模拟评分(VAS)于术后1月对患者的疼痛状况进行评估,术后1月的VAS评分降低<5分且缓解疼痛程度不足70%者定义为术后疼痛。查阅患者的病历和影像学资料,记录人体质量指数(BMI)、年龄、性别、糖尿病史、高血压病史,通过患者术前和术后的影像学检测,明确患者术后椎体高度恢复、腰椎骨密度T值、腰背部软组织受损、骨水泥渗漏、椎管内真空裂隙征(IVC)、椎旁肌脂肪变性、镇痛药物使用评分(AUS)、临床疗效。结果纳入120例患者,患者术前VAS评分为(7.29±0.95)分,术后1月VAS评分为(2.62±0.63)分,术后1月进行VAS评估显示20例存在术后疼痛,发生率为16.67%(20/120)。术后无疼痛组和术后疼痛组患者性别、BMI、高血压病史、糖尿病史、AUS评分、手术疗效差异均无统计学意义(P>0.05)。术后无疼痛组和术后疼痛组患者在年龄、筋膜受损、椎体中间高度恢复、椎体前缘高度恢复、术后感染、骨水泥渗漏、骨密度、椎旁肌脂肪变性、IVC方面差异均有统计学意义(P<0.05)。二元Logistic回归分析结果显示,筋膜受损、椎体中间高度恢复不足3.00 mm、骨密度<3.5 g/m^(3)、骨水泥渗漏、椎旁肌脂肪变性2~4级、有IVC为影响老年VCF患者术后疼痛的影响因素(P<0.05)。结论筋膜受损、椎体中间高度恢复不足、低骨密度、骨水泥渗漏、有椎管内真空裂隙征、椎旁肌脂肪变性程度较高可能是老年VCF患者椎体成形术后发生疼痛的主要因素,临床应采取针对性措施以缓解患者的疼痛情况,改善患者预后。Objective To analyze the related influencing factors of pain after vertebroplasty in elderly patients with vertebral compression fracture(VCF),provide necessary reference for clinical intervention and improve the prognosis of elderly patients.Methods A total of 120 elderly patients with thoracolumbar VCF treated by vertebroplast in Department of Spinal Surgery,Second People s Hospital of Lianyungang City from January 2023 to January 2024 were retrospectively selected.Visual analog scale(VAS)was used to evaluate the pain status of the patients one month after surgery.The postoperative pain was defined as a decrease of less than 5 points in the VAS score and pain relief of less than 70%one month after surgery.Their medical records and imaging data were reviewed and their body mass index(BMI),age,sex,history of diabetes,history of hypertension were recorded.Preoperative and postoperative imaging examinations were performed to determine the postoperative vertebral height recovery,lumbar bone density T value,lumbar and back soft tissue damage,bone cement leakage,intraspinal vacuum fissure sign(IVC),paravertebral steatosis,analgesic drug use score(AUS),and clinical efficacy.Results A total of 120 patients were included.Their preoperative VAS score was(7.29±0.95)points,and the VAS score one month after surgery was(2.62±0.63)points.VAS evaluation conducted one month after surgery showed that 20 patients had postoperative pain,with an incidence of 16.67%(20/120).There was no significant difference in gender,BMI,history of hypertension,history of diabetes,AUS score and surgical efficacy between the postoperative pain group and the postoperative pain-free group(P>0.05).There were significant differences in age,fascia damage,intermediate vertebral height recovery,anterior vertebral edge height recovery,postoperative infection,bone cement leakage,bone mineral density,paravertebral steatosis and IVC between the two groups(P<0.05).Binary logistic regression analysis showed that damaged fascia,less than 3.00 mm of intermediate

关 键 词：老年 椎体压缩性骨折 椎体成形术 术后疼痛 影响因素 

分 类 号：R47[医药卫生—护理学]