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经皮椎体后凸成形术后残余腰背痛的危险因素分析
作者:高剑峰  袁景  沈文东  张军强  刘亦凡  汤月平 
单位:南京医科大学附属苏州医院 骨科, 江苏 苏州 215000
关键词:经皮椎体后凸成形术 残余腰背痛 骨质疏松性椎体压缩性骨折 危险因素分析 
分类号:R816.8
出版年·卷·期(页码):2021·49·第十一期(1297-1302)
摘要:

目的:探讨经皮椎体后凸成形术(PKP)后残余腰背痛的发生率以及危险因素。方法:选取2014年6月至2016年1月因骨质疏松性椎体压缩性骨折在我院行PKP治疗的患者455例。术后VAS评分≥4分定义为术后残余腰背痛,作为残余腰背痛组。术后无残余腰背痛患者中随机抽取同等例数作为对照组。比较两组年龄、性别、术前骨密度(BMD)值、骨折数量及类型、骨水泥分布及用量、胸腰筋膜损伤情况、伤椎前缘高度及后凸角等变量并对其进行单因素和多因素Logistic回归分析。结果:43例患者出现术后残余腰背痛症状,发生率为9.5%。残余腰背痛组和对照组在术前BMD值、骨折数量、骨折类型、骨水泥分布、胸腰筋膜损伤情况、术后伤椎高度以及术后伤椎后凸角度方面差异均具有统计学意义(均P<0.05)。Logistic回归分析结果显示:术前BMD值(OR=2.57,P=0.015)、骨折数量(OR=3.28,P<0.001)、Ⅰ型骨折OR=4.05,P=0.018)、O型骨水泥分布(OR=2.13,P=0.005)、胸腰筋膜损伤(OR=5.21,P=0.041)以及术后伤椎后凸角度(OR=3.59,P=0.027)是PKP术后残余腰背痛呈独立相危险因素。结论:PKP术后残余腰背痛的发生率为9.5%,且术前BMD值低、骨折数量多、Ⅰ型骨折、O型骨水泥分布、出现胸腰筋膜损伤以及术后伤椎后凸角大是PKP术后出现残余腰背痛的独立危险因素。

Objective: To investigate the incidence and risk factors for postoperative residual back pain after percutaneous kyphoplasty(PKP). Methods: 455 patients with osteoporotic vertebral compression fracture (OVCF) who treated with PKP from June 2014 to January 2016 were selected. Postoperative VAS score≥4 was defined as residual back pain. Patients with VAS≥4 were enrolled into residual back pain group. The same number of patients without postoperative residual back pain were randomly selected as the control group. Comparison of age, gender, preoperative bone mineral density (BMD) value, number and type of vertebral fracture, volume and distribution of bone cement, thoracolumbar fascia injury, the anterior height and kyphotic angle of fractured vertebrae between two groups were analyzed by univariate and multivariate logistic regression. Results: 43 patients (9.5%) were presented with postoperative residual back pain. The preoperative BMD value, the number of fractured vertebrae, the type of fractured vertebrae, bone cement distribution, thoracolumbar fascia injury, postoperative height of fractured vertebrae and postoperative kyphotic angle of fractured vertebrae were significantly different between two groups (P<0.05). Multivariate logistic regression analysis revealed that preoperative BMD value (OR=2.57, P=0.015), the number of fractured vertebrae (OR=3.28, P<0.001), type I vertebral fracture (OR=4.05, P=0.018), O type of bone cement distribution (OR=2.13, P=0.005), thoracolumbar fascia injury (OR:=5.21, P=0.041) and postoperative kyphotic angle of fractured vertebrae (OR=3.59, P=0.027) were independently correlated with postoperative residual back pain after percutaneous kyphoplasty.Conclusions: The incidence of postoperative residual back pain after percutaneous kyphoplasty was 9.5%. In addition, preoperative low BMD value, multi-segmental vertebral fracture, type I vertebral fracture, O type of bone cement distribution, the presence of thoracolumbar fascia injury and postoperative big kyphotic angle of fractured vertebrae were independent risk factors for residual back pain after percutaneous kyphoplasty.

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