| 椎体强化术后早期与后期残留腰背痛的原因分析 |
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Received:June 19, 2021
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| 作者 | Author | 单位 | Unit | E-Mail |
| 陈晨 |
CHEN Chen |
浙江中医药大学第二临床医学院, 浙江 杭州 310053
浙江中医药大学附属第二医院骨伤科, 浙江 杭州 310005 |
Department of Traumatology and Orthopaedics, the Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang, China |
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| 安忠诚 |
AN Zhong-cheng |
浙江中医药大学附属第二医院骨伤科, 浙江 杭州 310005 |
Department of Traumatology and Orthopaedics, the Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang, China |
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| 吴连国 |
WU Lian-guo |
浙江中医药大学附属第二医院骨伤科, 浙江 杭州 310005 |
Department of Traumatology and Orthopaedics, the Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang, China |
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| 庞哲栋 |
PANG Zhe-dong |
浙江中医药大学第二临床医学院, 浙江 杭州 310053 |
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| 肖连根 |
XIAO Lian-gen |
浙江中医药大学第二临床医学院, 浙江 杭州 310053 |
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| 魏浩 |
WEI Hao |
浙江中医药大学附属第二医院骨伤科, 浙江 杭州 310005 |
Department of Traumatology and Orthopaedics, the Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang, China |
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| 董黎强 |
DONG Li-qian |
浙江中医药大学附属第二医院骨伤科, 浙江 杭州 310005 |
Department of Traumatology and Orthopaedics, the Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang, China |
dlq58@126.com |
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| 期刊信息：《中国骨伤》2022年35卷，第8期，第724-731页 |
| DOI：10.12200/j.issn.1003-0034.2022.08.005 |
| 基金项目:浙江省中医药现代化专项项目（编号：2021ZX009）；国家中医临床研究基地支撑学科建设计划（编号：2020-JDXK-ZC01） |
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目的：探讨骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fractures，OVCFs）在经皮椎体强化（percutaneous vertebral augmentation，PVA）术后早期和后期残留腰背痛的影响因素，并对这些因素的相关性进行分析。
方法：收集2018年3月至2019年12月住院行PVA治疗的312例OVCFs患者，根据病例选择标准，共纳入240例患者的临床资料进行回顾性研究，其中男59例，女181例，年龄50~95（76.11±10.72）岁，骨折节段分布在胸椎区（T5-T10）50例，胸腰椎区（T11-L2）159例，腰椎区（L3及以下）31例。将术后第1天视为术后早期，术后第7天视为术后后期，再结合患者的视觉模拟评分（visual analogue scale，VAS）将患者分为术后早期疼痛缓解明显组（A组，VAS评分≤ 4），共有患者121例，其中男29例，女92例，年龄50~90（75.71±11.00）岁；术后早期疼痛缓解不明显组（B组，VAS评分>4），共有患者119例，男30例，女89例，年龄53~95（76.51±10.46）岁；术后后期疼痛缓解明显组（C组，VAS评分≤ 4），共有患者172例，男42例，女130例，年龄50~95（76.20±10.68）岁；术后后期疼痛缓解不明显组（D组，VAS评分>4），共有患者68例，男17例，女51例，年龄53~94（75.88±10.91）岁。统计4组患者的年龄、性别、骨密度、伤椎节段、术前胸腰椎筋膜损伤情况、术式选择、术中单双侧穿刺情况、骨水泥注入量、椎体前缘高度及中央高度恢复情况，并对这些因素进行单因素分析，将其中有统计学意义的因素代入Logistic回归模型中，分析它们与PVA术后残留腰背痛的相关性。
结果：单因素分析结果示，PVA术后早期残留腰背痛与骨密度、术前胸腰椎筋膜损伤情况、单双侧穿刺情况、骨水泥注入量、椎体前缘高度及中央高度恢复情况相关（P<0.05）；术后后期残留腰背痛与骨密度、伤椎节段、术式选择、骨水泥注入量、椎体前缘高度及中央高度恢复情况相关（P<0.05）。多因素Logistic回归分析结果示，在术后早期，合并胸腰椎筋膜损伤情况（OR=4.938，P=0.001），单双侧穿刺情况（OR=5.073，P=0.002）与术后残留腰背痛症状存在正相关的关系（B>0），是其危险因素；而骨密度（OR=0.211，P=0.000），椎体前缘高度恢复情况（OR=0.866，P=0.001）则与术后残留腰背痛症状存在负相关的关系（B<0），是其保护性因素；在术后后期，骨密度（OR=0.448，P=0.003），骨水泥总量（OR=0.648，P=0.004），椎体前缘高度恢复情况（OR=0.820，P=0.000）与术后残留腰背痛症状存在负相关的关系（B<0），是其保护性因素。
结论：骨密度降低、胸腰椎筋膜损伤、术中单双侧穿刺情况、椎体前缘的高度恢复不良及骨水泥注入量不足与PVA术后残留腰背痛的发生关系密切，影响术后早期及后期的腰背部疼痛缓解。 |
| [关键词]:骨质疏松 椎体成形术 脊柱骨折 腰背痛 手术后并发症 |
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| Analysis of the causes of residual back pain in the early and late stages after percutaneous vertebral augmentation |
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Abstract:
Objective: To explore the influencing factors of the residual back pain in patient with osteoporotic vertebral compression fractures(OVCFs) in the early and late stages after percutaneous vertebral augmentation(PVA), and analyze the correlation between these factors and the residual back pain after PVA.
Methods: From March 2018 to December 2019, 312 patients with OVCFs who treated with PVA were collected. According to the inclusion and exclusion criteria, a total of 240 patients were included in this retrospective study. There were 59 males and 181 females, aged from 50 to 95 years old with an average of (76.11±10.72) years old, and 50 cases of fractures located in the thoracic region (5-T10), 159 cases in the thoracolumbar region (T11-L2), and 31 cases in the lumbar region (L3 and below). The first day after PVA was regarded as the early postoperative period, and the seventh day was regarded as the late postoperative period. According to the visual analogue scale (VAS), the patients were divided into 4 groups:early postoperative pain relief group(group A, VAS ≤ 4 scores), there were 121 patients, including 29 males and 92 females, aged from 50 to 90 years with an average of (75.71±11.00) years;early postoperative pain relief was not an obvious group (group B, VAS >4 scores), there were 119 patients, including 30 males and 89 females, aged from 53 to 95 years with an average of (76.51±10.46) years; late postoperative pain relief group (group C, VAS ≤ 4 scores), there were 172 patients, including 42 males and 130 females, aged from 50 to 95 years with an average of (76.20±10.68) years; late postoperative pain relief was not obvious group (group D, VAS>4 scores), there were 68 patients, including 17 males and 51 females, aged from 53 to 94 years old with an average of (75.88±10.91) years old. The age, gender, bone mineral density(BMD), injured vertebral segment, preoperative thoracolumbar fascial condition, surgical methods, single or bilateral puncture, the amount of bone cement injection, anterior vertebral height recovery rate and central vertebral height recovery rate in the 4 groups were analyzed by univariate analysis. The statistically significant factors were put into a Logistic regression to analyze the correlation between these factors and residual back pain after PVA.
Results: Univariate analysis showed that the residual back pain in the early stage after PVA was correlated with BMD, preoperative thoracolumbar fascial injury, single or bilateral puncture, the amount of bone cement injection, anterior vertebral height recovery rate and central vertebral height recovery rate(P<0.05). The residual back pain in the late postoperative period was related to BMD, injured vertebral segment, surgical methods, the amount of bone cement injection, anterior vertebral height recovery rate and central vertebral height recovery rate(P<0.05). Multivariate Logistic regression analysis showed that thoracolumbar fascial injury(OR=4.938, P=0.001), single or bilateral puncture(OR=5.073, P=0.002) were positively correlated with the residual back pain in the early stage after PVA(B>0), which were risk factors;the BMD (OR=0.211, P=0.000) and anterior vertebral height recovery rate (OR=0.866, P=0.001) were negatively correlated with the residual back pain in the early stage after PVA(B<0), which were protective factors. In the late stage after PVA, the BMD(OR=0.448, P=0.003), the amount of bone cement injection (OR=0.648, P=0.004) and anterior vertebral height recovery rate (OR=0.820, P=0.000) were negatively correlated with residual back pain(B<0), which were protective factors.
Conclusion: The decrease of BMD, injury of the thoracolumbar fascia, single or bilateral puncture, poor recovery of anterior vertebral height and insufficient injection of bone cement are closely related to the occurrence of residual back pain after PVA, which affect the relief of residual back pain in the early and late postoperative periods. |
| KEYWORDS:Osteoporosis Vertebroplasty Spinal fractures Residual back pain Postoperative complications |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 陈晨,安忠诚,吴连国,庞哲栋,肖连根,魏浩,董黎强.椎体强化术后早期与后期残留腰背痛的原因分析[J].中国骨伤,2022,35(8):724~731 |
| 英文格式: | CHEN Chen,AN Zhong-cheng,WU Lian-guo,PANG Zhe-dong,XIAO Lian-gen,WEI Hao,DONG Li-qian.Analysis of the causes of residual back pain in the early and late stages after percutaneous vertebral augmentation[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(8):724~731 |
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