骨质疏松性椎体压缩骨折PKP术后脊柱-骨盆矢状位失平衡对继发骨折、生存质量的影响

Effect of spine-pelvic sagittal imbalance after PKP on the secondary fracture and quality of life in osteoporotic vertebral compression fractures

目的探讨骨质疏松性椎体压缩骨折(OVCF)经皮椎体后凸成形术(PKP)术后脊柱-骨盆矢状位失平衡对继发骨折、生存质量的影响。方法回顾性分析2017年12月—2019年6月徐州市中医院骨科收治的57例OVCF患者的临床资料,男性34例,女性23例;年龄50~70岁,平均58.35岁。患者均在术前采用腰椎双能量X线吸收测量法对骨密度进行测量并记录T值,采用自动检测仪测量并计算患者BMI值。所有患者脊柱-骨盆矢状位平衡参数测量在行PKP术后进行,根据患者术后是否继发骨折(术后1年内)分为正常组(27例)及骨折组(30例)。比较两组患者骨密度、BMI、脊柱-骨盆矢状位平衡参数及生存质量[根据VAS评分、日本骨科协会评估治疗分数(JOA)、Oswestry功能障碍指数(ODI)指标判断]。结果患者随访12~18个月,平均15.13个月。(1)两组术前骨密度及BMI比较差异无统计学意义(P>0.05);(2)骨折组患者矢状面偏移(SVA)、胸椎后凸角(TK)大于正常组,腰椎前凸角(LL)、骶骨倾斜角(SS)、骨盆入射角(PI)小于正常组(P<0.05);两组胸腰椎后凸角(TLK)、骨盆倾斜角(PT)比较差异无统计学意义(P>0.05);(3)末次随访时正常组患者生存质量评分显著优于骨折组(P<0.05)。结论较小的SVA、TK及较大的LL、SS、PI在OVCF患者PKP术后继发性骨折中起到一定的保护作用。

Objective To explore the effect of spine-pelvic sagittal imbalance after percutaneous kyphoplasty(PKP)on secondary fractures and quality of life in patients with osteoporotic vertebral compression fracture(OVCF).Methods A retrospective analysis was conducted in the clinical data of 57 OVCF patients,who were admitted to the Department of Orthopedics,Xuzhou Hospital of Traditional Chinese Medicine from Dec.2017 to Jun.2019.There were 34 males and 23 females,with an average age of 58.35 years(range,50 to 70 years).Before operation,the patients used the dual-energy X-ray absorptiometry of the lumbar spine to measure the bone density and record the T value,and the automatic detector was used to measure and calculate the patient's BMI value.All patients were measured for spine-pelvic sagittal balance parameters after PKP.According to whether the patients had secondary fractures(within 1 year after surgery),they were divided into normal group(27 cases)and fracture group(30 cases).The bone mineral density,BMI,spine-pelvic sagittal balance parameters and quality of life were compared between the two groups(judged according to the scores of VAS,JOA,and ODI).Results All patients were followed up for 12-18 months,with an average of 15.13months.(1)There was no significant difference in bone mineral density and BMI between the two groups before operation(P>0.05);(2)The sagittal plane deviation(SVA)and thoracic kyphosis(TK)of the fracture group were greater than those of the normal group.Lumbar lordosis(LL),sacral inclination angle(SS),and pelvic incidence angle(PI)were smaller than those in the normal group(P<0.05);the difference in the thoracolumbar kyphosis(TLK)and pelvic inclination(PT)was not significant between the two groups(P>0.05).(3)The quality of life score of the normal group was significantly better than that of the fracture group at the last follow-up(P<0.05).Conclusion Smaller SVA,TK and larger LL,SS,PI play a certain protective role in the occurrence of secondary fractures after PKP in OVCF patients.