老年胸腰椎骨质疏松性椎体压缩性骨折经皮椎体成形术治疗效果不佳的影响因素分析

Analysis of Influencing Factors for the Poor Clinical Efficacy of Percutaneous Vertebroplasty in the Treatment of Thoracolumbar Osteoporotic Vertebral Compression Fracture in Elderly Patients

目的探讨分析老年胸腰椎骨质疏松性椎体压缩性骨折(OVCF)经皮椎体成形术(PVP)治疗效果不佳的影响因素。方法选取2021年1月至2022年1月安阳市第三人民医院收治的82例行PVP治疗的老年胸腰椎OVCF患者作为研究对象,收集患者性别、年龄、体重指数(BMI)、术前骨密度(BMD)、骨折椎体数、有无高血压、有无糖尿病、手术入路方式、单个椎体骨水泥注入量、有无骨水泥渗漏、术后是否规范行抗骨质疏松治疗等资料,并根据PVP术后1个月的治疗效果将其分为效果满意组和效果不佳组,多因素Logistic回归分析老年胸腰椎OVCF患者PVP治疗效果不佳的相关影响因素。结果82例老年胸腰椎OVCF患者PVP术后1个月治疗效果满意67例(81.71%),设为效果满意组;治疗效果不佳15例(18.29%),设为效果不佳组。单因素分析结果显示,效果不佳组患者年龄明显大于效果满意组(t=3.745,P<0.001),术前BMD明显小于效果满意组(t=2.914,P=0.005),骨折椎体数≥2个、有骨水泥渗漏以及术后未规范行抗骨质疏松治疗者比例均明显高于效果满意组(χ^(2)=9.019、13.988、13.566,P=0.003、P<0.001、P<0.001),单个椎体骨水泥注入量明显少于效果满意组(t=6.158,P<0.001)。多因素Logistic回归分析结果显示,高龄、术前BMD低、骨折椎体数≥2个及有骨水泥渗漏是老年胸腰椎OVCF患者PVP治疗效果不佳的独立危险因素(95%CI为1.517~12.797、2.298~16.314、1.774~19.234、1.328~17.859,P=0.006、0.000、0.004、0.017)。结论PVP治疗老年胸腰椎OVCF的效果可受患者年龄、术前BMD、骨折椎体数及有无骨水泥渗漏影响。

Objective To analyze the influencing factors for the poor clinical efficacy of percutaneous vertebroplasty(PVP)in the treatment of thoracolumbar osteoporotic vertebral compression fracture(OVCF)in elderly patients.Methods 82 elderly patients with thoracolumbar OVCF who received the PVP operation in Anyang Third People’s Hospital from January 2021 to January 2022 were selected as research subjects.Data of these subjects were collected including sex,age,body mass index(BMI),preoperative bone mineral density(BMD),number of fractured vertebra,with hypertension and diabetes or not,surgical approach,bone cement injection volume for single vertebra,with leakage of bone cement or not,whether receiving postoperative standardized anti-osteoporosis treatment or not.The patients were divided into effective treatment group and poor treatment group based on the clinical efficacy one month after PVP operation.Multivariate Logistic regression analysis was used to analyze the related influencing factors for poor clinical efficacy of PVP in the treatment of thoracolumbar OVCF in elderly patients.Results Among the 82 elderly patients with thoracolumbar OVCF,67 cases(8171%)were satisfied with the clinical efficacy one month after PVP operation,being set as the effective treatment group,and the other 15 cases(1829%)with poor clinical efficacy were set as the poor treatment group.The results of univariate analysis showed that the age of patients in the poor treatment group was significantly older than that in the effective treatment group(t=3745,P<0001),the preoperative BMD was significantly lower in the poor treatment group(t=2914,P=0005),the proportions of patients with more than two fractured vertebras,patients with leakage of bone cement and patients without standardized anti-osteoporosis treatment after operation were significantly higher in the poor treatment group compared with the effective treatment group(χ^(2)=9019,13988 and 13566,P=0003,P<0001,P<0001),and the bone cement injection volume for single vertebra in the poor treatment group was significantly less than that in the effective treatment group(t=6158,P<0001).Multivariate Logistic regression analysis showed that advanced age,low preoperative BMD,with more than two fractured vertebras and the leakage of bone cement were independent risk factors for poor clinical efficacy of PVP in the treatment of thoracolumbar OVCF in elderly patients(95%CI:1517-12797,2298-16314,1774-19234,1328-17859,P=0006,0000,0004 and 0017).Conclusion The therapeutic effect of PVP in the treatment of thoracolumbar OVCF in elderly patients is affected by patients’age,preoperative BMD,number of fractured vertebrae and leakage condition of bone cement.