脊柱骨盆矢状面平衡参数对老年单节段骨质疏松压缩性骨折行PKP术后继发椎体骨折的影响

Effect of spino-pelvic sagittal alignment parameters on secondary vertebral fracture after percutaneous kyphoplasty in elderly patients with single segmental osteoporotic vertebral compression fracture

目的探讨脊柱骨盆矢状面平衡参数对老年单节段骨质疏松压缩性骨折(OVCF)行经皮球囊扩张椎体后凸成形术(PKP)术后继发椎体骨折的影响。方法回顾性分析2016年12月-2018年12月在四川省第二中医医院骨伤科确诊并行PKP治疗的128例单节段OVCF患者的临床资料,根据PKP术后是否继发椎体骨折将其分为继发组(n=60)和未继发组(n=68),在站立位全脊柱侧位X线片上测量脊柱骨盆矢状面平衡参数,比较两组手术相关资料、VAS评分、ODI评分、脊柱骨盆矢状面平衡参数。结果两组骨水泥用量差异无统计学意义(t=1.446,P=0.151);两组手术节段、手术入路差异无统计学意义(χ^2=0.187、0.008,P=0.911、0.929)。继发组VAS评分、ODI评分明显高于未继发组(t=5.717、9.935,P=0.000、0.000)。两组胸腰椎后凸角(TLK)、骨盆倾斜角(PT)差异无统计学意义(t=0.953、1.086,P=0.342、0.279)。继发组矢状面偏移(SVA)明显高于未继发组(Z=-9.142,P=0.000),胸椎后凸角(TK)明显高于未继发组(t=3.827,P=0.000),腰椎前凸角(LL)、骶骨倾斜角(SS)、骨盆入射角(PI)明显低于未继发组(t=4.002、4.794、4.078,P=0.000、0.000、0.000)。结论较小SVA、TK及较大LL、SS、PI可减小老年单节段骨质疏松压缩性骨折患者PKP术后继发椎体骨折的概率。

Objective To investigate the effect of spino-pelvic sagittal alignment parameters on secondary vertebral fracture after percutaneous kyphoplasty(PKP) in elderly patients with single segmental osteoporotic vertebral compression fracture(OVCF).Methods The clinical data of 128 patients with single-segmental OVCF underwent PKP from Dec.2016 to Dec.2018 were retrospectively analyzed.The patients were divided into secondary group(n=60) and non-secondary group(n=68) according to presence or absence of secondary vertebral fracture.The measured sagittal parameters including sagittal vertical axis(SVA),thoracic kyphosis(TK),thoracolumbar kyphosis(TLK),1 umbar lordosis(LL),sacral slope(SS),pelvic tilt(PT),and pelvic incidence(PI) angle were obtained on the standing posteroanterior and lateral radiographs.Then the surgical data,visual analogue scale(VAS),Oswestry Dysfunction Index(ODI),and measured sagittal parameters were compared between the two groups.Results No significant difference was found in bone cement dosage(t=1.446,P=0.151),moreover,the surgical segment and surgical approach either showed no difference between the two groups(χ^2=0.187,0.008,P=0.911,0.929).The VAS and ODI scores in the secondary group were significantly higher than those in the non-secondary group(t=5.717,9.935;P=0.000,0.000).No significant difference was found in TLK and PT between the two groups(t=0.953,1.086;P=0.342,0.279).The SVA in the secondary group was significantly higher than that in the non-secondary group(Z=-9.142,P=0.000).The TK in the secondary group was significantly higher than that in the non-secondary group(t=3.827,P=0.000).The LL,SS and PI in the secondary group were significantly lower than those in the non-secondary group(t=4.002,4.794,4.078;P=0.000,0.000,0.000).Conclusion Lower SVA and TK as well as higher LL,SS and PI are more likely to have decreased secondary vertebral fracture rate after PKP.