| 杨俊松,陈 浩,刘 鹏,刘团江,赵元廷,邹 鹏,张正平,贺宝荣,闫 亮,拓 源,郝定均.经皮椎体成形术治疗胸腰椎骨质疏松性椎体压缩骨折疗效不佳的多因素分析[J].中国脊柱脊髓杂志,2020,(1):45-52. |
| 经皮椎体成形术治疗胸腰椎骨质疏松性椎体压缩骨折疗效不佳的多因素分析 |
| 中文关键词: 骨质疏松性椎体压缩骨折 经皮椎体成形术 腰背部疼痛 危险因素 多因素分析 |
| 中文摘要: |
| 【摘要】 目的：探讨胸腰椎骨质疏松性压缩骨折（thoracolumbar osteoporotic vertebral compression fractures， TOVCF）采用经皮椎体成形术（percutaneous vertebroplasty，PVP）治疗后临床疗效不佳的危险因素。方法：回顾性分析2013年3月～2016年3月在我院就诊并行PVP治疗的1974例TOVCF患者。收集患者的人口统计学资料（性别、年龄、身高、体重）、手术及影像学资料、患者合并症等相关信息，术后1周、1个月、3个月和1年时的腰背部疼痛视觉模拟评分（visual analogue scale, VAS）和Oswestry功能障碍指数（Oswestry disability index, ODI）。将术后1周及术后1个月VAS评分均>4分视为术后腰背部疼痛缓解不佳，将其归为疼痛缓解不佳组，并从疼痛缓解满意的患者中随机抽取相同例数有术后1个月胸腰椎MRI且随访资料完整的患者作为对照组，对两组患者进行比较分析。结果：在1974例TOVCF患者中，共有81例患者术后1周及术后1个月的VAS评分均>4分，占患者总数的4.1%。疼痛缓解不佳组与对照组比较，术前及术后1年随访时的VAS评分和ODI无统计学差异（P>0.05），术后1周、1个月、3个月时存在显著性差异（P<0.05）。在所纳入的各项观察指标中，两组术前骨密度（bone mineral density，BMD）、骨折椎体数、骨水泥分布情况、单椎体骨水泥注入量、术前或术后1个月胸腰筋膜损伤的发生率及抑郁症人数存在显著性差异（P<0.05）。多因素分析显示，术前BMD低（OR=3.475，P=0.025）、术前或术后1个月存在胸腰筋膜损伤（OR=3.952，P=0.003）、骨折椎体数多（OR=3.640，P<0.0001）、骨水泥分布不佳（OR=3.216，P=0.016）、单椎体骨水泥注入量不足（OR=0.081，P<0.0001）、合并抑郁症（OR=3.616，P=0.014）是PVP术后腰背部疼痛缓解不佳的独立危险因素。结论：术前低BMD、术前或术后1个月存在胸腰筋膜损伤、多椎体骨折、单椎体骨水泥注入量不足及分布不佳、合并抑郁症是TOVCF患者行PVP治疗后临床疗效不佳的危险因素。 |
Multivariate analysis of poor relief of back pain after percutaneous vertebroplasty for thoracolumbar osteoporotic vertebral compression fracture |
| 英文关键词:Osteoporotic vertebral compression fractures Percutaneous vertebroplasty Back pain Risk factor Multivariate analysis |
| 英文摘要: |
| 【Abstruct】 Objectives: To explore the risk factors of poor relief of back pain(PRBP) after percutaneous vertebroplasty(PVP) in patients with thoracolumbar osteoporotic vertebral compression fractures(TOVCF). Methods: From March 2013 to March 2016, 1974 patients with TOVCF were treated by PVP in our Hospital. Factors that might have an influence on the efficacy of pain relief were evaluated, including demographic data(age, gender, height and weight), surgical and radiographic data and comorbidities. All patients were followed up at 1 week, 1 month, 3 months, and 1 year after operation, visual analogue scale(VAS) scores and Oswestry disability index(ODI) were recorded at each time point. We defined PRBP after PVP as VAS score >4 at both 1 week and 1 month after operation. According to the pain relief, the patients were divided into two groups, the satisfactory group and the unsatisfactory group. Results: Among 1974 patients, 81 cases complained PRBP, the prevalence was 4.1%. There was no significant difference of VAS score and ODI between the two group before operation and at 1 year after operation(P>0.05), while there were significant differences between the two group at 1 week, 1 month and 3 months after operation(P<0.05). Univariate analyses showed that there were significant differences of the preoperative bone mineral density(BMD), number of fractures, cement distribution and volume injected per level, the prevalence of thoracolumbar fascia injury preoperatively or at 1 month after operation, depression between these two groups respectively(P<0.05). Multivariate analysis revealed that pre-operative lower BMD[odds ratio(OR)=3.475, P=0.025], the existence of thoracolumbar fascia injury preoperatively or at 1 month after operation(OR=3.952, =0.003), higher number of fractures(OR=3.640, P<0.0001), unsatisfactory cement distribution(OR=3.216, P=0.016), insufficient cement volume injected per level(OR=0.081, P<0.0001), and depression(OR=3.616, P=0.014) were independently associated with PRBP after PVP at the early post-operative stage. Conclusions: pre-operative lower BMD, thoracolumbar fascia injury preoperatively or at 1 month after operation, higher number of vertebral fractures, unsatisfactory cement injected volume and distribution, depression were the risk factors of PRBP after PVP in patients with TOVCF. |
| 投稿时间：2019-09-23 修订日期：2019-12-02 |
| DOI： |
| 基金项目:国家自然科学基金重点项目（81830077） |
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