[1]罗金金,丁彩田.骨质疏松性椎体压缩骨折经皮椎体后凸成形术后脊柱后凸畸形改善程度的影响因素分析[J].中医正骨,2022,34(08):8-11.
　LUO Jinjin,DING Caitian.Analysis of factors influencing the degree of improvement of spinal kyphosis deformity after percutaneous kyphoplasty for treatment of osteoporotic vertebral compression fracture[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(08):8-11.
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骨质疏松性椎体压缩骨折经皮椎体后凸成形术后脊柱后凸畸形改善程度的影响因素分析()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期数:
2022年08期
页码:
8-11
栏目:
临床研究
出版日期:
2022-08-20

文章信息/Info

Title:
Analysis of factors influencing the degree of improvement of spinal kyphosis deformity after percutaneous kyphoplasty for treatment of osteoporotic vertebral compression fracture
作者:
罗金金1; 丁彩田2
(1.余姚市中医医院,浙江 余姚 315400; 2.义乌市中心医院,浙江 义乌 322000)
Author(s):
LUO Jinjin1; DING Caitian2
1.Yuyao Hospital of TCM,Yuyao 315400,Zhejiang,China 2.Yiwu Central Hospital,Yiwu 322000,Zhejiang,China
关键词:
骨质疏松性骨折;  骨折; 压缩性;  脊柱骨折;  后凸成型术;  脊柱后凸
Keywords:
osteoporotic fractures;  fractures; compression;  spinal fractures;  kyphoplasty;  kyphosis
摘要:
目的:探讨骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)后脊柱后凸畸形改善程度的影响因素。方法:收集2018年11月至2020年11月在余姚市中医医院接受PKP治疗的OVCF患者的病例资料,包括患者的性别、年龄、骨折节段、病程、骨密度T值、体质量指数、骨水泥注入量、骨水泥渗漏椎体数等资料。提取患者手术前后的脊柱X线片,测量手术前后的伤椎椎体高度和Cobb角,计算伤椎椎体前缘高度比、伤椎椎体中间高度比和脊柱后凸畸形改善程度。比较手术前后伤椎椎体前缘高度比、伤椎椎体中间高度比、伤椎Cobb角的变化情况。观察年龄、病程、骨密度T值、体质量指数、骨水泥注入量、骨水泥渗漏椎体数、术前伤椎椎体前缘高度比、术前伤椎椎体中间高度比、术前伤椎Cobb角与脊柱后凸畸形改善程度的相关性,并采用多因素Logistic回归分析研究OVCF 患者PKP术后脊柱后凸畸形改善程度的影响因素。结果:①一般结果。纳入研究的患者共150例,男79例、女71例,年龄(71.51±5.65)岁,骨折节段为T955例、T1042例、T1153例,病程(9.90±4.72)d,骨密度T值-3.12±0.34,体质量指数(21.35±1.73)kg·m-2,骨水泥注入量(4.18±0.56)mL,骨水泥渗漏椎体数3个。患者术前、术后24 h、术后6个月伤椎椎体前缘高度比、伤椎椎体中间高度比、伤椎Cobb角的比较,总体差异有统计学意义[(62.13±10.27)%,(75.85±12.11)%,(76.12±12.09)%,F=50.620,P=0.000;(66.15±11.34)%,(80.26±12.63)%,(81.33±12.17)%,F=74.045,P=0.000; 18.01°±7.74°,12.52°±6.39°,12.01°±6.31°,F=24.802,P=0.000],术后24 h、术后6个月的伤椎椎体前缘高度比、伤椎椎体中间高度比、伤椎Cobb角均较术前改善(P=0.000,P=0.000; P=0.000,P=0.000; P=0.000,P=0.000)。②影响脊柱后凸畸形改善程度的单因素分析结果。年龄、病程、体质量指数、骨水泥渗漏椎体数与脊柱后凸畸形改善程度均不存在直线相关关系(r=0.652,P=0.086; r=-0.162,P=0.073; r=0.057,P=0.528; r=-0.103,P=0.276),骨水泥注入量、术前伤椎Cobb角与脊柱后凸畸形改善程度均呈正相关关系(r=0.211,P=0.024; r=0.625,P=0.000),骨密度T值、术前伤椎椎体前缘高度比、术前伤椎椎体中间高度比与脊柱后凸畸形改善程度均呈负相关关系(r=-0.521,P=0.000; r=-0.236,P=0.004; r=-0.342,P=0.000)。③影响脊柱后凸畸形改善程度的多因素Logistic回归分析结果。以骨密度T值、术前伤椎Cobb角、术前伤椎椎体前缘高度比、术前伤椎椎体中间高度比、骨水泥注入量为自变量,以脊柱后凸畸形改善程度为因变量,进行多因素Logistic回归分析。结果显示,骨密度T值、术前伤椎Cobb角是脊柱后凸畸形改善程度的影响因素(b=-1.339,P=0.000,OR=0.262; b=0.195,P=0.000,OR=1.215)。结论:术前伤椎Cobb角和骨密度是OVCF患者PKP术后脊柱后凸畸形改善程度的影响因素。
Abstract:
Objective:To explore the factors influencing the degree of improvement of spinal kyphosis deformity in patients with osteoporotic vertebral compression fracture(OVCF)after percutaneous kyphoplasty(PKP).Methods:The medical records of patients who underwent PKP for treatment of OVCF in Yuyao Hospital of TCM from November 2018 to November 2020 were collected,and their information including gender,age,fractured segment,disease course,T-value of bone mineral density(BMD),body mass index(BMI),consumption of bone cement and the number of vertebrae with bone cement leakage was extracted from the electronic medical record system,and the spinal X-ray films taken before and after the PKP were extracted for measuring presurgical and postsurgical height and Cobb's angle of injured vertebrae and calculating injured vertebrae anterior border height ratio,injured vertebrae middle height ratio and degree of improvement of spinal kyphosis.The changes of anterior border height ratio,middle height ratio and Cobb's angle of injured vertebrae were compared between pre-PKP and post-PKP.The correlations between the degree of improvement of spinal kyphosis and the factors including age,disease course,T-value of BMD,BMI,consumption of bone cement,the number of vertebrae with bone cement leakage,presurgical injured vertebrae anterior border height ratio,presurgical injured vertebrae middle height ratio,presurgical injured vertebrae Cobb's angle were analysed,and a multi-factor logistic regression analysis was conducted for researching the factors influencing the improvement degree of spinal kyphosis in OVCF patients after PKP.Results:①One hundred and fifty OVCF patients were enrolled in the study,including 79 males and 71 females with age,disease course,T-value of BMD,BMI,consumption of bone cement and the number of vertebrae with bone cement leakage as 71.51±5.65 years,9.90±4.72 days,-3.12±0.34 SD,21.35±1.73 kg/m(2),4.18±0.56 mL and 3; and the factures located at T9(55 cases),T10(42 cases)and T11(53 cases).There was statistical difference in anterior border height ratio,middle height ratio and Cobb's angle of injured vertebrae between pre-PKP,postsurgical hour 24 and postsurgical month 6 in general(62.13±10.27,75.85±12.11,76.12±12.09%,F=50.620,P=0.000; 66.15±11.34,80.26±12.63,81.33±12.17%,F=74.045,P=0.000; 18.01±7.74,12.52±6.39,12.01±6.31 degrees,F=24.802,P=0.000),and the anterior border height ratio,middle height ratio and Cobb's angle of injured vertebrae were improved at postsurgical hour 24 and month 6 compared to pre-PKP(P=0.000,P=0.000; P=0.000,P=0.000; P=0.000,P=0.000).②There was no linear correlations between the improvement degree of spinal kyphosis and the factors including age,disease course,BMI and the number of vertebrae with bone cement leakage(r=0.652,P=0.086; r=-0.162,P=0.073; r=0.057,P=0.528; r=-0.103,P=0.276).The improvement degree of spinal kyphosis was positively correlated with the consumption of bone cement and presurgical injured vertebrae Cobb's angle(r=0.211,P=0.024; r=0.625,P=0.000),while was negatively correlated with the T-value of BMD,presurgical injured vertebrae anterior border height ratio and presurgical injured vertebrae middle height ratio(r=-0.521,P=0.000; r=-0.236,P=0.004; r=-0.342,P=0.000).③The multi-factor logistic regression analysis was conducted by taking T-value of BMD,presurgical injured vertebrae Cobb's angle,presurgical injured vertebrae anterior border height ratio,presurgical injured vertebrae middle height ratio and consumption of bone cement as independent variable and the improvement degree of spinal kyphosis as dependent variable respectively,and the results showed that the T-value of BMD and presurgical injured vertebrae Cobb's angle were the factors influencing the improvement degree of spinal kyphosis(b=-1.339,P=0.000,OR=0.262; b=0.195,P=0.000,OR=1.215).Conclusion:The presurgical injured vertebrae Cobb's angle and BMD are the factors influencing the improvement degree of spinal kyphosis in OVCF patients after PKP.

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(收稿日期:2021-11-17 本文编辑:郭毅曼)

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通讯作者:罗金金 E-mail:hingislgg@163.com
更新日期/Last Update: 1900-01-01