骨质疏松性椎体压缩骨折经皮椎体成形术后残留腰骶部疼痛的危险因素分析  

Analysis of risk factors for lumbosacral pain after percutaneous vertebroplasty for osteoporotic vertebral compression fractures

作　　者：金凤 倪国玉[1] 李锦军[1] 费琦[1] 孟海[1] JIN Feng;NI Guoyu;LI Jinjun;FEI Qi;MENG Hai(Department of Orthopedics,Beijing Friendship Hospital Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院骨科中心,北京100050

出　　处：《中国骨与关节损伤杂志》2025年第1期28-32,共5页Chinese Journal of Bone and Joint Injury

摘　　要：目的 分析骨质疏松性椎体压缩骨折经皮椎体成形术后残留腰骶部疼痛的影响因素。方法 回顾性分析自2021-06-2022-12采用经皮椎体成形术治疗的224例骨质疏松性椎体压缩骨折,根据术后第3天是否存在腰骶部疼痛分组,比较两组术后第3天、术后3个月腰骶部疼痛VAS评分。将术后第3天是否存在腰骶部疼痛作为因变量,将性别、年龄、体质量指数、骨密度T值、病程、高血压病史、糖尿病史、慢性肺部疾病史、术前腰骶筋膜损伤、椎体成形手术史、骨折椎体、抗骨质疏松治疗、手术入路、骨水泥注入量、骨水泥分布情况、骨水泥渗漏作为自变量,进行单因素分析和多因素Logistic回归分析。结果 224例手术顺利完成并获得至少1年随访,术后第3天37例出现腰骶部疼痛,发生率为16.5%。残留腰骶部疼痛患者大多为轻中度疼痛,进行消炎、镇痛、物理治疗、局部封闭、抗骨质疏松治疗后疼痛逐步缓解。残留腰骶部疼痛患者术后3个月VAS评分为(1.73±0.84)分,无腰骶部疼痛患者术后3个月VAS评分为(1.63±0.62)分,组间差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,术前腰骶筋膜损伤、椎体成形手术史、骨水泥注入量、骨水泥渗漏是骨质疏松性椎体压缩骨折经皮椎体成形术后残留腰骶部疼痛的危险因素。结论 骨质疏松性椎体压缩骨折经皮椎体成形术后残留腰骶部疼痛与术前腰骶筋膜损伤、椎体成形手术史、骨水泥注入量、骨水泥渗漏密切相关,临床医师需要对这些潜在的危险因素保持高度警觉,并采取相应措施降低术后腰骶部疼痛的发生率。Objective To analyse the risk factors for the development of lumbosacral pain after percutaneous vertebroplasty(PVP)for osteoporotic vertebral compression fractures(OVCF).Methods Two hundred and twenty-four OVCF patients who un-derwent PVP surgery from June 2021 to December 2022 were retrospectively analyzed,and were grouped according to the pres-ence or absence of lumbosacral pain on the postoperative day 3.VAS scores for lumbosacral pain were compared between the two groups on the postoperative day 3 and at 3 months postoperatively.The presence or absence of lumbosacral pain on the postopera-tive day 3 was used as the dependent variable,while gender,age,body mass index,bone mineral density T-value,disease dura-tion,history of hypertension,history of diabetes mellitus,history of chronic lung disease,preoperative lumbosacral fascia injury,history of vertebroplasty,fractured vertebrae,anti-osteoporosis treatment,surgical access,amount of cement injected,distribu-tion of cement,and cement leakage were used as the independent variables.Univariate analysis as well as multivariate logistic re-gression analysis was performed.Results All patients underwent operations successfully and were followed up for at least 1 year.Thirty-seven cases developed lumbosacral pain on the 3rd postoperative day,with an incidence of 16.5%.Most of the pa-tients with residual lumbosacral pain had mild to moderate pain,which was gradually relieved after anti-inflammatory,analge-sic,physiotherapy,local blocking,and anti-osteoporotic treatment.The VAS score of patients with residual lumbosacral pain was(1.73±0.84)at 3 months after surgery,and the VAS score of patients without lumbosacral pain was(1.63±0.62)at 3 months after surgery,the difference between the groups was not statistically significant(P>0.05).The results of multivariate logistic re-gression analysis showed that preoperative lumbosacral fascia injury,history of vertebroplasty,amount of cement injection,and cement leakage were risk factors for residual lumbosacral pain after PVP

关 键 词：骨质疏松性椎体压缩骨折 经皮椎体成形术 腰骶部疼痛 影响因素 

分 类 号：R687.3[医药卫生—骨科学]