胸腰段OVCF患者矢状面失衡与PVP术后椎体再塌陷的相关性

Correlation between sagittal imbalance and vertebral body collapse after PVP in patients with thoracolumbar OVCF

目的 探讨胸腰段骨质疏松性椎体压缩骨折(OVCF)患者矢状面失衡(SI)与经皮椎体成形术(PVP)术后再塌陷的相关性。方法 选择2018年1月至2020年12月在该院接受PVP治疗的167例OVCF患者资料进行分析,根据PVP术后是否再塌陷,将患者分为塌陷组和未塌陷组。观察患者术前SI发生率及SI对PVP术后再塌陷的独立影响,观察是否SI患者在不同时间的胸腰椎后凸角(TKA)和矢状垂直轴(SVA)值变化。结果 167例患者随访至12个月时,共有38例符合再塌陷的定义标准,纳入再塌陷组;剩余129例患者纳入未塌陷组。再塌陷组患者术前SVA、术前SI均显著高于未塌陷组(P<0.05)。再塌陷和未再塌陷组患者的骨密度、既往OVCF史、骨水泥渗漏、骨水泥团块样形态、骨折区骨水泥弥散不足、动态活动度、胸腰椎后凸角等资料差异存在统计学意义(P<0.05)。多因素Logistic分析结果显示,术前SI是骨水泥强化椎体再塌陷的独立风险因素之一(P<0.05)。SI组和非SI组患者术后不同时间的TKA和SVA均呈进展趋势,组内比较均有统计学意义(F=48.072、36.492、11.457、9.122,P均<0.05);与非SI组比较,SI组随访1年TKA和SVA的差值均高于非SI组患者,差异均有统计学意义(t=5.082、4.377,P<0.05)。结论 SI、骨密度、动态活动度、骨水泥团块状分布、骨折区骨水泥弥散不足等是胸腰椎OVCF患者PVP术后椎体再塌陷的风险因素,SI与术后矢状位进展相关,对潜在的SI患者应给予严格管理以减少术后椎体再塌陷。

Objective To investigate the correlation between sagittal imbalance(SI)of thoracolumbar osteoporotic vertebral compression fracture(OVCF)and re collapse after percutaneous vertebroplasty(PVP).Methods The data of 167 patients with OVCF who received PVP treatment in our hospital from January 2018 to December 2020 were analyzed.According to whether PVP collapsed again after surgery,the patients were divided into collapse group and non collapse group.The incidence of Si before operation and the independent effect of Si on the re collapse after PVP were observed.Whether the changes of TKA and SVA values in patients with SI at different times were observed.Results Among 167 patients who were followed up to 12 months,38 patients met the definition criteria of re collapse and were included in the re collapse group.The remaining 129 patients were included in the non collapse group.The preoperative SVA and Si of patients in the re collapse group were higher than those in the non collapse group(P<0.05).There were significant differences in bone mineral density,previous OVCF history,bone cement leakage,bone cement lumps,lack of bone cement in the fracture area,dynamic mobility,thoracolumbar kyphosis angle between the re collapse group and the non re collapse group(P<0.05).Multivariate logistic analysis showed that preoperative Si was an independent risk factor for re collapse of vertebral bodies strengthened with bone cement(P<0.05).TKA and SVA of patients in Si and non Si groups showed a progressive trend at different times,and there was significant difference between the two groups(F=48.072,36.492,11.457,9.122,P<0.05).Compared with the non Si Group,the difference of TKA and SVA in the Si group was higher than that in the non Si Group at the follow-up of 1 year,and the difference was statistically significant(t=5.082,4.377,P<0.05).Conclusion SI,bone density,dynamic mobility,massive distribution of bone cement,and insufficient bone cement dispersion in fracture area are risk factors for vertebral body re collapse after PVP in patients with thoracolumbar OVCF.SI is related to the progress of sagittal position after surgery,and potential SI patients should be strictly managed to reduce vertebral body re collapse after surgery.