老年骨质疏松性脊柱骨折患者椎体成形术后预后影响因素分析

Analysis of prognostic factors in elderly patients with osteoporotic spinal fractures after vertebroplasty

目的探究老年骨质疏松性脊柱骨折患者椎体成形术后预后的影响因素。方法回顾性分析2017年1月至2019年2月首都医科大学附属北京同仁医院80例行椎体成形术的老年骨质疏松性脊柱骨折患者的临床资料,根据预后将患者分为预后良好组和预后不良组,分析老年骨质疏松性脊柱骨折患者椎体成形术后预后的影响因素。结果本研究共纳入80例患者,27例(33.75%)术后出现并发症,将其纳入预后不良组,其余53例患者纳入预后良好组。术前两组患者视觉模拟评分法(visual analogue scale,VAS)评分和Oswestry功能障碍指数(Oswestry disability index,ODI)比较差异均无统计学意义(均P>0.05);术后1年,预后良好组患者VAS评分和ODI均显著低于预后不良组(均P<0.05)。两组患者年龄、是否使用激素、有无骨折史、有无出现骨水泥渗漏、是否行抗骨质疏松治疗、恢复期有无发生意外事故、营养供给是否不足占比比较差异均有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示,年龄≥80岁、使用激素、有骨折史、出现骨水泥渗漏、未进行抗骨质疏松治疗、恢复期发生意外事故、营养供给不足均为老年骨质疏松性脊柱骨折患者椎体成形术后不良预后的危险因素(均P<0.05)。结论老年骨质疏松性脊柱骨折患者椎体成形术后预后不良发生率较高,主要与患者年龄、激素使用情况、骨折史、骨水泥渗漏情况、抗骨质疏松治疗情况、恢复期发生意外事故以及营养供给情况相关,因此在治疗和恢复过程中需要针对相关因素给予患者个性化治疗。

Objective To explore the factors affecting the prognosis of elderly patients with osteoporotic spinal fractures after vertebroplasty.Method The clinical data of 80 elderly patients with osteoporotic spinal fracture who underwent vertebroplasty from January 2017 to February 2019 in Beijing Tongren Hospital,Capital Medical University were analyzed retrospectively.The patients were divided into good prognosis group and poor prognosis group according to their prognosis.To analyze the factors affecting the prognosis of elderly patients with osteoporotic spinal fractures after vertebroplasty.Result A total of 80 patients were included in this study,27 patients(33.75%)had postoperative complications,they were included into poor prognosis group,and the remaining 53 patients were included into good prognosis group.There were no significant differences in visual analogue scale(VAS)scores and Oswestry disability index(ODI)between the two groups before operation(all P>0.05).One year after operation,the VAS score and ODI of patients in good prognosis group were significantly lower than those of patients in poor prognosis group(all P<0.05).There were significant differences in the proportion of patients between the two groups in age,use hormones,history of fracture,bone cement leakage,anti-osteoporosis treatment,accidents in the recovery period and insufficient nutrition supply(all P<0.05).Multivariate Logistic regression analysis showed that age≥80 years old,use hormone,fracture history,bone cement leakage,no anti-osteoporosis treatment,accident during recovery and insufficient nutrition supply were all risk factors for poor prognosis of elderly patients with osteoporotic spinal fracture after vertebroplasty(all P<0.05).Conclusion The incidence of poor prognosis of elderly patients with osteoporosis spinal fractures after vertebroplasty is higher,mainly due to patients'age,hormone use,fracture history,bone cement leakage,anti-osteoporosis treatment,accidents during recovery and insufficient nutrition supply,so patients need to be given personalized treatment according to relevant factors during the treatment and recovery process.