影响经皮球囊扩张椎体后凸成形术治疗骨质疏松性椎体压缩骨折效果的相关因素分析

Analysis of relative factors o n clinical result of osteoporotic vertebral compression fractures with percutaneous kyphoplasty

目的探讨经皮球囊扩张椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩骨折(OVCFs)临床疗效的影响因素。方法对2006年3月～2011年3月在河北省石家庄市第一医院骨二科因OVCFs行经皮椎体成形术(PVP)或PKP手术的120例患者进行回顾性分析,分别记录患者的年龄、性别、骨折椎体数目、骨密度、椎体压缩程度及骨水泥注入量。按年龄、性别、椎体数目、骨密度、椎体压缩程度、骨水泥注入量及手术方式的不同分别分组后,比较各组JOA评分的改善率。结果所有患者获得术后随访12个月以上,最长随访时间61个月,平均25.8个月;男54例,女66例;年龄47～97岁,平均64.5岁;JOA评分改善率为(52.7±21.3)%。按骨密度、骨折椎体数目及术后椎体压缩程度的不同分组后,每组JOA评分改善率差异有统计学意义(P<0.05);按年龄、性别、术前椎体压缩程度、骨水泥注入量及手术方式的不同分组后,每组JOA评分改善率差异无统计学意义(P>0.05)。Logistic多元回归分析显示骨密度、术后椎体压缩程度、骨折椎体数目是影响JOA评分改善率的主要因素(OR=5.217、3.163、1.924,P<0.05)。结论 PKP治疗OVCFs具有较好的临床疗效,明确病椎数目并准确定位,尽可能恢复病椎高度,合理应用抗骨质疏松药物,才能取得满意的临床效果。

Objective To analyze the relative factors on clinical result of osteoporotic vertebral compression fractures with percutaneous kyphoplasty. Methods The clinical data of 120 patients who were operated on the osteoporotic vertebral compression fractures with the percutaneous vertebroplasty or the percutaneous kyphoplasty in Fisrt Hospital of Shijiazhuang City from March 2006 to March 2011. The age, gender, amount of fractured vertebral body, BMD, degree of vertebral compression and amount of bone cement were recorded. Different groups were divided according to different age, gender, amount of fractured vertebral body, BMD, degree of vertebral compression, amount of bone cement and operative methods and the JOA recovery rate of different groups were compared. Results All patients who including 54 male and 66 female aged 47 to 97 years old （average 64.5 years old） were follow up for more than 12 months. The JOA recovery rate was （52.7±21.3）%. the difference of JOA recovery rate had statistical significance according to the difference of the BMD, amount of fractured vertebral body and degree of postoperative vertebral compression （P 〈 0.05）, but had not statistical significance according to the difference of the age, gender, degree of preoperative verte- bral compression, amount of bone cement and operative methods （P 〉 0.05）. The analysis of Logistic multiple regres- sion showed that the BMD, amount of fractured vertebral body and degree of postoperative vertebral compression were primary effective factors on the JOA recovery rate （OR = 5.217, 3.163 and 1.924, P 〈 0.05）. Conclusion The percutaneous kyphoplasty is better method to treat with osteoporotic vertebral compression fractures and could obtain satisfied clinical results as long as to certify the right symptomatic vertebra, recover the height of fractured vertebra as far as possible and use rationally antiosteoporosis drugs.