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不同微创术式治疗椎体压缩性骨折的疗效及预后影响因素分析。

Effectiveness and prognostic factors of different minimally invasive surgeries for vertebral compression fractures.

机构信息

Department of Orthopaedics, The First Affiliated Hospital of Jiangxi Medical College, Shangrao, 334000, China.

Department of Orthopaedics, Fengcheng People's Hospital of Jiangxi Province, Fengcheng, 331100, China.

出版信息

BMC Musculoskelet Disord. 2023 Jan 6;24(1):11. doi: 10.1186/s12891-022-06125-8.

Abstract

BACKGROUND

The aging of China's population has led to an increase in the incidence rate of osteoporosis, which indirectly increases the risk of OVCF in osteoporosis patients. Low back pain is the main symptom of OVCF, and severe patients can further develop kyphosis. Although the conservative treatment of OVCF can effectively control the patient's condition, long-term bed rest will increase the risk of OVCF complications. Minimally invasive surgery is a common solution for OVCF.

METHODS

100 OVCF patients admitted to our hospital from January 2021 to January 2022 are selected for analysis and randomly divided into PVP group and PKP group, 50 cases in each group. The PVP group and the PKP group undergo PVP and PKP operations respectively. The differences in efficacy indicators and adverse reactions are compared, and the multivariate Logistic regression method is used to analyze the influencing factors of postoperative secondary fractures in patients with vertebral compression fractures.

RESULTS

Compared with the PVP group, the total effective rate of PKP group is significantly increased, and the VAS, ODI score, kyphotic Cobb Angle, lateral distribution rate of bone cement and bone cement leakage rate are significantly decreased (P < 0.05). Age ≥ 80 years old, female, glucocorticoid use, lateral distribution of bone cement and bone cement leakage are significantly higher in the proportion of secondary fractures and are independent risk factors for postoperative secondary fractures in patients with OVCF.

CONCLUSION

PKP surgery has a higher efficacy in the treatment of OVCF patients, which can reduce the incidence of pain, adverse reactions and promote the recovery of kyphotic Cobb Angle. PKP surgery has a higher value in the treatment of OVCF. In addition, the influencing factors of secondary fracture after minimally invasive surgery in OVCF patients include age, gender, glucocorticoid use, bone cement distribution pattern, bone cement leakage, etc.

摘要

背景

中国人口老龄化导致骨质疏松症发病率上升,这间接增加了骨质疏松症患者 OVCF 的风险。腰背痛是 OVCF 的主要症状,严重者可进一步发展为后凸畸形。虽然 OVCF 的保守治疗可以有效控制患者病情,但长期卧床会增加 OVCF 并发症的风险。微创手术是 OVCF 的常见解决方案。

方法

选择我院 2021 年 1 月至 2022 年 1 月收治的 100 例 OVCF 患者进行分析,随机分为 PVP 组和 PKP 组,每组 50 例。PVP 组和 PKP 组分别行 PVP 和 PKP 手术,比较两组疗效指标和不良反应的差异,采用多因素 Logistic 回归方法分析影响椎体压缩性骨折患者术后继发性骨折的因素。

结果

与 PVP 组相比,PKP 组总有效率明显升高,VAS、ODI 评分、后凸 Cobb 角、骨水泥侧方分布率及骨水泥渗漏率明显降低(P<0.05)。年龄≥80 岁、女性、使用糖皮质激素、骨水泥侧方分布及骨水泥渗漏比例较高的患者继发性骨折比例明显较高,是 OVCF 患者术后继发性骨折的独立危险因素。

结论

PKP 手术治疗 OVCF 患者的疗效较高,可降低疼痛、不良反应发生率,促进后凸 Cobb 角恢复。PKP 手术在 OVCF 治疗中有较高的应用价值。此外,OVCF 患者微创术后发生继发性骨折的影响因素包括年龄、性别、糖皮质激素使用、骨水泥分布模式、骨水泥渗漏等。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cd04/9817397/6fcc041755df/12891_2022_6125_Fig1_HTML.jpg

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