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[1]羅金金,丁彩田.骨質(zhì)疏松性椎體壓縮骨折經(jīng)皮椎體后凸成形術(shù)后脊柱后凸畸形改善程度的影響因素分析[J].中醫(yī)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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骨質(zhì)疏松性椎體壓縮骨折經(jīng)皮椎體后凸成形術(shù)后脊柱后凸畸形改善程度的影響因素分析()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期數(shù):
2022年08期
頁碼:
8-11
欄目:
臨床研究
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:
羅金金1; 丁彩田2
(1.余姚市中醫(yī)醫(yī)院,浙江 余姚 315400; 2.義烏市中心醫(yī)院,浙江 義烏 322000)
Author(s):
LUO Jinjin1; DING Caitian2
1.Yuyao Hospital of TCM,Yuyao 315400,Zhejiang,China 2.Yiwu Central Hospital,Yiwu 322000,Zhejiang,China
關(guān)鍵詞:
骨質(zhì)疏松性骨折;  骨折; 壓縮性;  脊柱骨折;  后凸成型術(shù);  脊柱后凸
Keywords:
osteoporotic fractures;  fractures; compression;  spinal fractures;  kyphoplasty;  kyphosis
摘要:
目的:探討骨質(zhì)疏松性椎體壓縮骨折(osteoporotic vertebral compression fracture,OVCF)經(jīng)皮椎體后凸成形術(shù)(percutaneous kyphoplasty,PKP)后脊柱后凸畸形改善程度的影響因素。方法:收集2018年11月至2020年11月在余姚市中醫(yī)醫(yī)院接受PKP治療的OVCF患者的病例資料,包括患者的性別、年齡、骨折節(jié)段、病程、骨密度T值、體質(zhì)量指數(shù)、骨水泥注入量、骨水泥滲漏椎體數(shù)等資料。提取患者手術(shù)前后的脊柱X線片,測量手術(shù)前后的傷椎椎體高度和Cobb角,計算傷椎椎體前緣高度比、傷椎椎體中間高度比和脊柱后凸畸形改善程度。比較手術(shù)前后傷椎椎體前緣高度比、傷椎椎體中間高度比、傷椎Cobb角的變化情況。觀察年齡、病程、骨密度T值、體質(zhì)量指數(shù)、骨水泥注入量、骨水泥滲漏椎體數(shù)、術(shù)前傷椎椎體前緣高度比、術(shù)前傷椎椎體中間高度比、術(shù)前傷椎Cobb角與脊柱后凸畸形改善程度的相關(guān)性,并采用多因素Logistic回歸分析研究OVCF 患者PKP術(shù)后脊柱后凸畸形改善程度的影響因素。結(jié)果:①一般結(jié)果。納入研究的患者共150例,男79例、女71例,年齡(71.51±5.65)歲,骨折節(jié)段為T955例、T1042例、T1153例,病程(9.90±4.72)d,骨密度T值-3.12±0.34,體質(zhì)量指數(shù)(21.35±1.73)kg·m-2,骨水泥注入量(4.18±0.56)mL,骨水泥滲漏椎體數(shù)3個。患者術(shù)前、術(shù)后24 h、術(shù)后6個月傷椎椎體前緣高度比、傷椎椎體中間高度比、傷椎Cobb角的比較,總體差異有統(tǒng)計學意義[(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],術(shù)后24 h、術(shù)后6個月的傷椎椎體前緣高度比、傷椎椎體中間高度比、傷椎Cobb角均較術(shù)前改善(P=0.000,P=0.000; P=0.000,P=0.000; P=0.000,P=0.000)。②影響脊柱后凸畸形改善程度的單因素分析結(jié)果。年齡、病程、體質(zhì)量指數(shù)、骨水泥滲漏椎體數(shù)與脊柱后凸畸形改善程度均不存在直線相關(guān)關(guān)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、術(shù)前傷椎Cobb角與脊柱后凸畸形改善程度均呈正相關(guān)關(guān)系(r=0.211,P=0.024; r=0.625,P=0.000),骨密度T值、術(shù)前傷椎椎體前緣高度比、術(shù)前傷椎椎體中間高度比與脊柱后凸畸形改善程度均呈負相關(guān)關(guān)系(r=-0.521,P=0.000; r=-0.236,P=0.004; r=-0.342,P=0.000)。③影響脊柱后凸畸形改善程度的多因素Logistic回歸分析結(jié)果。以骨密度T值、術(shù)前傷椎Cobb角、術(shù)前傷椎椎體前緣高度比、術(shù)前傷椎椎體中間高度比、骨水泥注入量為自變量,以脊柱后凸畸形改善程度為因變量,進行多因素Logistic回歸分析。結(jié)果顯示,骨密度T值、術(shù)前傷椎Cobb角是脊柱后凸畸形改善程度的影響因素(b=-1.339,P=0.000,OR=0.262; b=0.195,P=0.000,OR=1.215)。結(jié)論:術(shù)前傷椎Cobb角和骨密度是OVCF患者PKP術(shù)后脊柱后凸畸形改善程度的影響因素。
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 本文編輯:郭毅曼)

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通訊作者:羅金金 E-mail:[email protected]
更新日期/Last Update: 1900-01-01