骨质疏松性胸腰椎椎体压缩骨折患者脊柱-骨盆矢状位参数与经皮椎体成形术疗效的相关性研究

Relationship between sagittal parameters of spine-pelvis and effect of percutaneous vertebroplasty in patients with osteoporotic thoracolumbar vertebral body compression fractures

目的观察骨质疏松性胸腰椎椎体压缩骨折(OVCF)患者脊柱-骨盆矢状参数与经皮椎体成形术(PVP)疗效的相关性。方法选取扬州市中医院脊柱科2015年1月至2019年12月收治的腰椎压缩性骨折行椎体强化手术患者100例,术后随访≥12个月,观察PVP手术前、术后1周及末次随访(≥12个月)患者脊柱骨盆参数及疗效,分析PVP手术后1周及末次随访(≥12个月)脊柱-骨盆矢状参数与疗效(ODI指数、VAS评分)的相关性。结果椎体强化术后1周、末次随访(≥12个月)较术前骨盆入射角(PI)、腰椎前凸角(LL)、胸腰后凸角(TLK)、骶骨倾斜角(SS)增大,骨盆倾斜角(PT)明显减少,差异有统计学意义(P<0.05);ODI指数、VAS评分降低,差异有统计学意义(P<0.05)。术后1周、PVP末次随访(>12个月)时脊柱-骨盆矢状参数与ODI、VAS评分的Pearson相关分析结果显示,SS、PT、LL的变化与ODI、VAS评分改善有显著相关性(P<0.05);TLK与ODI、VAS无显著相关性(P>0.05)。结论椎体强化术能迅速改善脊柱-骨盆矢状面平衡,手术疗效显著;早期及中长期的疗效的改善与脊柱骨盆矢状面参数的恢复呈相关性。

Objective To observe the relationship between sagittal parameters of the spine-pelvis and effect of percutaneous vertebroplasty(PVP)in patients with osteoporotic thoracolumbar vertebral body compression fractures(OVCF).Methods A total of 100 patients with lumbar compression fracture treated in Traditional Chinese Medicine Hospital of Yangzhou from January 2015 to December 2019 who underwent vertebral body strengthening surgery were selected.Postoperative follow-up was≥12 months,and the spinal and pelvic parameters and efficacy of the patients before PVP operation,1 week after surgery and the last follow-up(≥12 months)were observed.The relationship between sagittal parameters of spine and pelvis and efficacy(ODI index,VAS score)was analyzed 1 week after PVP operation and the last follow-up(≥12 months).Results One week after vertebral body strengthening,the last follow-up(≥12 months)compared with preoperative PI,LL,TLK,SS increased,PT significantly decreased,the differences were significant(P<0.05).ODI index and VAS score were decreased,and the difference was significant(P<0.05).Pearson correlation analysis of sagittal parameters of spine-pelvis and ODI and VAS scores at 1 week after surgery and the last follow-up of PVP(>12 months)showed that the changes of SS,PT and LL were significantly correlated with the improvement of ODI and VAS scores(P<0.05).There was no significant realationship between TLK and ODI,VAS(P>0.05).Conclusions Vertebral body strengthening can improve the sagittal balance of spine and pelvis rapidly,and the surgical effect is significant.Early and medium to longterm improvement was correlated with recovery of sagittal parameters of the spine and pelvis.