PKP治疗骨质疏松性椎体压缩骨折的预后评价及继发危险因素分析

目的:分析椎弓根入路行椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩骨折的预后评价及继发危险因素分析。方法:选择2016年2月-2018年2月我院收治的骨质疏松性椎体压缩骨折患者85例纳入本次研究,采用随机数表法分为观察组(n=43)和对照组(n=42)。对照组使用经皮椎体成形术进行治疗,观察组采用PKP进行治疗。比较两组患者手术情况、术后情况、椎体前缘高度丢失率、Cobb角、继发性骨折发生情况及分析骨质疏松性椎体压缩骨折患者术后继发骨折的危险因素。结果:观察组手术时间、透视次数、骨水泥注入量、术中出血量均显著低于对照组,差异显著(P0.05);观察组疼痛缓解时间、下地时间及住院时间均显著低于对照组,差异显著(P0.05);治疗前,两组椎体前缘高度丢失率、Cobb角比较,无显著差异;治疗后,两组患者的椎体高度丢失率明显下降,但两组术后7 d、术后6月两组椎体前缘高度丢失率、Cobb角比较无显著差异;观察组术后12月椎体前缘高度丢失率、Cobb角低于对照组,差异显著(P0.05);所有患者均随访12月,其中22例(25.88%)发生继发性椎体骨折,进行单因素分析,结果发现,两组患者性别、骨折部位、局部矢状面后凸角度、骨水泥量、椎体高度恢复、术后抗骨质疏松治疗差异无统计学意义(P0.05);骨质疏松原因、骨水泥椎间隙渗漏、术后支具佩戴、原发骨折类型与骨质疏松性椎体压缩骨折患者术后发生继发骨折相关(P0.05)。多因素Logistic分析显示,骨质疏松原因、骨水泥椎间隙渗漏、术后支具佩戴、原发骨折类型均是骨质疏松性椎体压缩骨折患者术后发生继发骨折的独立危险因素(P0.05)。结论:在骨质疏松性椎体压缩骨折患者中应用PKP可有效改善手术情况,随着时间的延长,PKP更有利于维持患者椎体高度;骨质疏松原因、骨水泥椎间隙渗漏、术后支具佩戴、原发骨折类型是骨质疏松性椎体压缩骨折患者术后发生继发骨折的危险因素,临床上对于具有危险因素的患者引起重视,并采取干预措施。

Prognostic Evaluation and Secondary Risk Factors Analysis of Osteoporotic Vertebral Compression Fracture Treated by PKP

ABSTRACT Objective: To study prognostic evaluation and secondary risk factors analysis of osteoporotic vertebral compression fracture treated by transpedicular approach for kyphoplasty (PKP). Methods: 85 patients with osteoporotic vertebral compression fracture admitted to our hospital from February 2016 to February 2018 were selected to be included in this study and randomly divided into the observation group (n=43) and the control group (n=42). The control group was treated with percutaneous vertebroplasty and the observation group was treated with PKP. The operation situation, postoperative status, anterior vertebral height loss rate, Cobb Angle and postoperative secondary fractures were compared between the two groups. The risk factors of postoperative secondary fractures in patients with osteoporotic vertebral compression fracture were analyzed. Results: The operative time, number of fluoroscopy, amount of bone cement injection and intraoperative blood loss in the observation group were significantly lower than those in the control group, with significant differences (P<0.05). The time of pain relief, time on the ground and length of hospital stay in the observation group were significantly lower than those in the control group, with significant differences (P<0.05). Before treatment, there was no significant difference in the loss rate and Cobb Angle of anterior vertebral edge height between the two groups. After treatment, the loss rate of vertebral body height in the two groups decreased significantly, but there was no significant difference in the loss rate of vertebral anterior margin height and Cobb Angle between the two groups 7 days after surgery and 6 months after surgery. The anterior vertebral height loss rate and Cobb Angle of the observation group were lower than those of the control group 12 months after surgery, with significant differences (P<0.05). All the patients were followed up for 12 months, and 22 (25.88%) of them had secondary vertebral fractures. Uni-factor analysis showed that there was no statistically significant difference between the two groups in gender, fracture site, local sagittal kyphosis angle, bone cement volume, vertebral height recovery, and postoperative anti-osteoporosis treatment (P>0.05). The causes of osteoporosis, bone cement intervertebral space leakage, postoperative brace wearing, and primary fracture type were correlated with postoperative secondary fractures in patients with osteoporotic vertebral compression fracture (P<0.05). Multivariate Logistic analysis showed that the causes of osteoporosis, bone cement intervertebral space leakage, postoperative brace wearing and primary fracture type were all independent risk factors for postoperative secondary fractures in patients with osteoporotic vertebral compression fracture (P<0.05). Conclusion: In patients with osteoporotic vertebral compression fractures in the application of PKP can effectively improve the operation situation, with the extension of time, the PKP holds more conducive to maintaining vertebral body height; in patients withosteoporotic vertebral compression fractures of postoperative secondary fracture, osteoporosis causes, intervertebral bone cement leakage, postoperative brace wearing, and primary fracture type are risk factors; clinical for patients with these risk factors should be taken seriously, and intervention measures should be taken.