经伤椎内固定联合椎体成形术治疗骨质疏松性椎体骨折后活动功能低下的影响因素

Influencing factors of low mobility after treatment of osteoporotic vertebral fractures with internal fixation and vertebroplasty

目的探讨骨质疏松性椎体骨折(osteoporotic vertebral fractures,OVF)内固定术后日常生活活动功能(activities of daily living,ADL)低下的影响因素。方法选择2012年3月~2019年3月在本院就诊的OVF患者作为研究对象,收集患者人口学资料、临床特征和手术情况等资料,于术后6个月采用ADL量表评估患者的生活活动能力,以生活活动功能是否良好(ADL≤60分为不良,>60分为良好)将患者分为两组,观察两组患者临床特征是否存在差异。结果患者6个月时ADL≤60分者共31例,占35.63%。ADL良好组和ADL不良组患者的年龄、类固醇药物史、神经功能分级、骨密度值、椎体前缘压缩率、椎管占位、骨水泥渗漏、术前ODI等指标差异存在统计学意义(P<0.05)。二分类多因素Logistic回归分析显示,年龄≥75岁、骨水泥渗漏、骨密度<-3.5 SD是导致ADL不良的风险因素(P<0.05),神经功能分级是其保护性因素(P<0.05)。结论OVF患者内固定术后ADL不良发生率较高,应引起临床重视,并根据患者风险因素给予相应防治措施。

Objective To investigate the influencing factors of poor activities of daily living(ADL)after internal fixation of osteoporotic vertebral fractures(OVF).Methods OVF patients in our hospital from March 2012 to March 2019 were selected in this research.Demographic data,clinical characteristics and operation conditions of the patients were collected.ADL scale was used to evaluate the life activity ability of the patients at 6 months after operation.The patients were divided into two groups according to whether the life activity function was good(ADL≤60 was bad,ADL>60 was good).The clinical characteristics of the two groups were observed.Results At 6 months after operation,31 patients(35.63%)had ADL≤60.There were significant differences in age,steroid drug history,neurological function grade,bone mineral density,anterior vertebral compression rate,spinal canal space occupying,bone cement leakage and preoperative ODI between the two groups(P<0.05).Binary multivariate logistic analysis showed that age≥75 years old,bone cement leakage,bone mineral density<-3.5 SD were the risk factors for poor ADL(P<0.05),and neurological function classification was the protective factor(P<0.05).Conclusion The incidence rate of poor ADL in OVF patients after internal fixation is high,which should be paid attention in clinic,and the corresponding prevention and treatment measures should be given according to the risk factors of patients.