经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折对腰椎-骨盆拟合关系的影响

Effect of percutaneous kyphoplasty on lumbar-pelvic correlation in osteoporotic vertebral compressive fractures

目的探讨经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compressive fracture,OVCF)对腰椎-骨盆拟合关系的影响。方法根据纳入标准筛选2012年1月—2017年6月首诊为原发性骨质疏松患者63例为对照组,因单节段腰椎OVCF接受PKP治疗且资料完整者67例为观察组。两组患者性别、年龄、腰椎骨密度T值差异均无统计学意义(P>0.05)。观察组于术前及术后3 d采用疼痛视觉模拟评分(VAS)及功能障碍指数(ODI)评定腰部疼痛及功能;术前及术后1个月摄腰椎侧位X线片,测量腰椎前凸角(lumbar lordosis,LL)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS),对照组于初次确诊骨质疏松时腰椎侧位X线片测量上述指标。结果观察组患者均获随访,随访时间3~24个月,平均5.8个月。术后3 d,观察组VAS评分由(5.6±1.8)分降至(2.8±1.3)分,ODI由50.1%±5.0%降至18.2%±1.8%,差异均有统计学意义(t=14.082,P=0.000;t=47.011,P=0.000)。X线片测量,与对照组相比,观察组术前LL、PI、SS减小,PT增大,其中仅LL两组间差异有统计学意义(P<0.05)。观察组术后1个月LL及SS较术前明显增大(P<0.05)、PT明显减小(P<0.05)、PI差异无统计学意义(P>0.05)。对照组中LL与PI、SS成正相关(P<0.05),PI与PT、SS成正相关(P<0.05)。观察组术前及术后1个月PI与SS均成正相关(P<0.05)。结论OVCF患者丧失腰椎-骨盆正常拟合关系,PKP可重建腰椎曲度,但无法恢复腰椎前凸与骨盆正常生理拟合。

Objective To explore the effect of percutaneous kyphoplasty(PKP) on lumbar-pelvic correlation in osteoporotic vertebral compressive fracture(OVCF). Methods According to the inclusion criteria, 63 patients with primary osteoporosis between January 2012 and June 2017 were selected as the control group and 67 patients with singlesegment lumbar OVCF receiving PKP and complete clinical data were included as the observation group. There was no significant difference in gender, age, and lumbar spine bone density between the two groups(P>0.05). The visual analogue scale(VAS) score and Oswestry Disability Index(ODI) score were used to assess lumbar pain and function before operation and at 3 days after operation in the observation group;lumbar lordosis(LL), pelvic incidence(PI), pelvic tilt(PT), and sacral slope(SS) were measured in lumbar lateral X-ray films which were taken before PKP and at 1 month after PKP. The same parameters were measured in the lumbar lateral X-ray films which were taken at the time of initial diagnosis in the control group. Results All patients were followed up 3-24 months with an average of 5.8 months in the observation group. The VAS score decreased from 5.6±1.8 before PKP to 2.8±1.3 at 3 days after PKP(t=14.082, P=0.000);ODI decreased from 50.1%±5.0% before PKP to 18.2%±1.8%(t=47.011, P=0.000). Compared with the control group, the LL, PI, and SS decreased and the PT increased in the observation group, and only the difference in LL between the two groups was significant(P<0.05). In the observation group, the LL and SS significantly increased(P<0.05) and PT significantly decreased(P<0.05) at 1 month after operation when compared with preoperative ones, and PI decreased, but the difference was not significant(P>0.05). In the control group, LL was positively correlated with PI and SS(P<0.05);PI was positively correlated with PT and SS(P<0.05). In the observation group, PI was positively correlated with SS(P<0.05)before and after PKP. Conclusion OVCF patients lost the specific lumbar-pelvic correlation. PKP can restore lumbar lordosis, but it still can not restore the normal physiological fitting.