椎体强化术治疗骨质疏松性椎体骨折前后肺功能变化及相关因素分析

Changes of pulmonary function and related factors before and after percutaneous vertebral strengthening for osteoporotic vertebral compression fractures

[目的]探讨经皮椎体强化术治疗老年骨质疏松性椎体压缩骨折前后患者的肺功能变化,并探求引起其变化的相关因素。[方法]对45例经皮椎体强化术患者于术前和术后3 d进行VAS评分、活动能力评分,测量胸椎后凸角、局部后凸角、肺功能(VC、FEV1.0、FVC、MVV、ERV、通气储备百分比),分析肺功能的变化、探求引起其变化的相关因素及相关性。[结果]经皮椎体强化术后3 d时患者受损的VC、FVC、FEV1.0、MVV、ERV、通气储备百分比显著改善,胸椎后凸角在术后得到明显改善,骨折椎体局部后凸角术后明显改善,VAS评分明显降低,术后活动能力明显增加。胸椎后凸角与FVC、MVV呈明显负相关性,骨折椎体局部后凸角与肺功能各指标没有明显相关性,术后3 d胸椎后凸角改善值与FVC、FEV1.0、MVV提高值呈显著正相关性,局部后凸角改善值与肺功能改善值无显著统计学相关。疼痛评分在术前与VC呈显著负相关,在术后3 d与VC、FVC、FEV1.0呈显著负相关,术后3 d VAS改善值与FVC、FEV1.0、MVV提高值呈显著正相关。[结论]经皮椎体强化术后3 d时患者疼痛显著缓解,脊柱矢状面排列改善,活动能力增加,同时受损的VC、FVC、FEV1.0、MVV、ERV、通气储备百分比得到改善。

[Objective]To explore the changes of pulmonary function and related factors in perioperative period of percutaneous vertebroplasty for treatment the osteoporotic vertebral compression fractures. [Method]Forty- five patients,who underwent percutaneous vertebroplasty for osteoporotic vertebral compression fracture,were included into this study. Visual analogue scale for pain,activity scores,thoracic kyphosis angle,local kyphosis angle,and pulmonary function were measured and analyzed before and at 3 days after operation. [Result]Compared with those before operation,significant improvements in VAS,activity scores,thoracic kyphosis angle,local kyphosis angle were found in the patients,associated with remarkable enhancement in compromised pulmonary function,including VC,FVC,FEV1. 0,ERV,MVV and ventilation reserve percentage at 3 days after surgery. Thoracic kyphosis angle was significantly correlated with some pulmonary function indexes,such as FVC and MVV,conversely,local kyphosis angle was not related to any parameter of pulmonary function before and at 3 days after operation. The improved value of thoracic kyphosis angle was remarkably associated with the added value of FVC,FEV1. 0,and MVV（ P〈0.01）. However,there was no correlation between the improvement in local angle and the enhancement of pulmonary function. VAS was negatively correlated to VC before operation,and negatively correlated to VC,FVC and FEV1. 0 at 3 days after operation.[Conclusion]At 3 days after percutaneous vertebroplasty,pain dramatically relieved associated with improvement of spinal alignment on the sagittal plane,advanced activity capacity and enhancement of pulmonary function.