椎体后凸成形术后腰骶部晚期疼痛的相关因素研究

Factors related to late persistent lumbosacral pain secondary to percutaneous kyphoplasty for osteoporotic vertebral compression fracture

[目的]探讨影响椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗胸腰椎单节段骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)患者晚期出现腰骶部疼痛的相关因素。[方法]2018年1月-2019年12月,58例因单节段OVCF行PKP的患者纳入本研究。根据末次随访时是否存在持续腰骶部疼痛分为疼痛组和无痛组。单项因素比较和逻辑回归分析晚期持续腰骶部疼痛的相关因素。[结果]末次随访时,28例患者腰骶部疼痛持续4周,VAS评分≥4分,被纳入疼痛组,占总研究人数的48.28%。疼痛组与无痛组在年龄、性别构成、BMI、骨密度、住院时间的差异均无统计学意义(P>0.05)。与术前相比,两组患者术后0DI评分和VAS评分均显著下降(P<0.05)。末次随访时疼痛组的评分较术后3d有所增加(P<0.05),而无痛组的评分持续性下降(P<0.05)。末次随访时疼痛组的ODI评分和VAS评分显著高于无痛组(P<0.05)。影像指标方面,与术前相比,术后3d和末次随访时两组患者的腰椎前凸角(lumbar lordosis,LL)和骶骨倾斜角(sacrum slope,SS)显著增加(P<0.05),而骨盆倾斜角(pelvic tilt,PT)显著减少(P<0.05),骨盆入射角(pelvic incidence,PI)无显著变化(P>0.05)。末次随访时,疼痛组LL和SS均显著小于无痛组(P<0.05),而两组间PT和PI的差异均无统计学意义(P>0.05)。逻辑回归表明:末次随访时的LL(OR=0.627,P<0.05)和SS(OR=0.751,P<0.05)是出现晚期疼痛的保护因素。[结论]PKP治疗胸腰段单节段OVCF,保持脊柱-骨盆平衡的恢复有利于减少晚期腰骶部疼痛的发生。

[Objective]To explore the factors related to late persistent lumbosacral pain secondary to percutaneous kyphoplasty(PKP)for single-segment osteoporotic vertebral compression fracture(OVCF).[Methods]A total of 58 patients who underwent PKP for OVCF from January 2018 to December 2019 were included in this study.The patients were fall into the pain group and the pain-free group based on whether persistent lumbosacral pain presented at the latest follow-up.Univariate comparison and logistic regression were conducted to search the factors related to the late persistent lumbosacral pain.[Results]At the last follow-up,28 patients who had lumbosacral pain lasting for 4 weeks with VAS score≥4 were included in the pain group,accounting for 48.28%of the total study population.There were no significant differences in age,gender,BMI,bone mineral density and hospital stay between the pain group and the pain-free group(P>0.05).Compared with the preoperatively,the ODI scores and VAS scores in both groups decreased significantly(P<0.05).The scores in the pain group at the last follow-up increased compared with 3 days postoperatively(P<0.05),while in the painless group decreased continuously(P<0.05).The ODI scores and VAS scores in the pain group were significantly higher than those in the painless group at the last follow-up(P<0.05).In term of radiographic assessment,lumbar lordosis(LL)and sacrum slope(SS)significantly increased(P<0.05),while pelvic tilt(PT)significantly decreased(P<0.05),pelvic incidence(PI)remained unchanged(P>0.05)in both groups at 3 clays postoperatively and the latest follow-up compared with those preoperatively.At the last follow-up,LL and SS in the pain group were significantly lower than those in the painless group(P<0.05),and there was no significant difference in PT and PI between the two groups(P>0.05).As results of logistic regression,the LL(OR=0.627,P<0.05)and SS(OR=0.751,P<0.05)proved of protective factors for the occurrence of late lumbosacral pain.[Conclusion]The occurrence of late lumbosacral pain might be prevented by maintaining the spinopelvic balance on sagittal plane after PKP for single-segment thoracolumbar OVCF.