骨质疏松性胸腰椎压缩骨折经皮椎体强化治疗后残余痛的危险因素

Risk factors of residual pain after percutaneous vertebral augmentation for osteoporotic thoracolumbar compression fractures

背景:经皮椎体强化治疗后残余痛是影响患者生活质量的严重并发症之一,也是困扰临床医生的难题。目前已有一些研究分析了椎体强化治疗后残余痛的危险因素,但不够全面且发生机制不甚清晰。目的:分析骨质疏松性胸腰椎压缩骨折椎体强化治疗后残余痛的危险因素,并探讨其发生机制。方法:选择2019年10月至2021年1月在江苏省苏北人民医院脊柱外科接受经皮椎体强化治疗的骨质疏松性椎体压缩骨折的患者共217例。术后1周及术后1,3,6个月内任意一次随访目测类比评分≥4分则认为有术后残余痛,依据有无残余痛的情况分为残余痛组(n=33)、无残余痛组(n=184)。调查两组患者性别、年龄、体质量指数、病程、慢性病史、外伤史、骨折椎体部位、腰背痛史、腰背筋膜损伤、骨密度、邻椎骨折、手术方式、骨水泥量、骨水泥渗漏情况、术前椎体高度压缩率、术后椎体高度恢复率、术后Cobb角改善率等资料,采用单因素及多因素Logistic回归分析探讨患者术后残余痛的危险因素。结果与结论:①两组患者的性别、年龄、病程、慢性病史、骨折椎体部位、手术方式、骨水泥量、骨水泥渗漏情况、术前椎体高度压缩率比较,差异均无显著性意义(P>0.05);②两组患者的体质量指数、外伤史、腰背筋膜损伤、腰背痛史、骨密度、邻椎骨折、术后椎体高度恢复率、术后Cobb角改善率比较,差异均有显著性意义(P<0.05);③对相关因素进行Logistic回归分析显示,体质量指数、腰背筋膜损伤、骨密度、邻椎骨折、术后椎体高度恢复率、术后Cobb角改善率是术后残余腰痛的危险因素(P<0.05);④结果表明体质量指数、腰背筋膜损伤、骨密度、邻椎骨折、术后椎体高度恢复率、术后Cobb角改善率是引起术后残余痛的危险因素,在临床工作中应采取相应预防性措施,从而减少术后残余痛发生。

BACKGROUND:Residual pain after percutaneous vertebral augmentation is one of the serious complications affecting the quality of life of patients,and also a difficult problem for clinicians.At present,some studies have analyzed the risk factors of residual pain after vertebral body strengthening,but they are not comprehensive and the mechanism is not clear.OBJECTIVE:To analyze the risk factors of residual pain after vertebral body strengthening in osteoporotic thoracolumbar compression fractures,and to explore its mechanism.METHODS:A total of 217 patients with osteoporotic vertebral compression fractures who received percutaneous vertebral augmentation in the Department of Spinal Surgery,Northern Jiangsu People’s Hospital from October 2019 to January 2021 were selected.Postoperative residual pain was considered if the visual analogue scale score was≥4 at 1 week,1,3,and 6 months after surgery.According to whether there was residual pain,patients were divided into residual pain group(n=33)and no residual pain group(n=184).Gender,age,body mass index,the course of the disease,chronic medical history,history of trauma,vertebral fracture site,history of low back pain,lumbodorsal fascia injury,bone mineral density,adjacent vertebral fractures,surgical procedure,amount of bone cement,bone cement leakage,preoperative vertebral height compression rate,postoperative vertebral height recovery rate,and improvement rate of postoperative Cobb angle were surveyed between the two groups.Univariate and multivariate Logistic regression analyses were used to investigate the risk factors of postoperative residual pain.RESULTS AND CONCLUSION:(1)There was no significant difference in gender,age,course of disease,chronic history,vertebral fracture site,surgical method,amount of bone cement,bone cement leakage,and preoperative vertebral height compression rate between the two groups(P>0.05).(2)There were statistically significant differences in body mass index,trauma history,lumbodorsal fascia injury,history of low back pain,bone mineral density,adjacent vertebral fracture,postoperative vertebral height recovery rate,and improvement rate of postoperative Cobb angle between the two groups(P<0.05).(3)Logistic regression analysis showed that body mass index,lumbodorsal fascia injury,bone mineral density,adjacent vertebral fractures,postoperative vertebral height recovery rate,and improvement rate of postoperative Cobb angle were the risk factors for postoperative residual low back pain(P<0.05).(4)The results showed that body mass index,lumbodorsal fascia injury,bone mineral density,adjacent vertebral fractures,postoperative vertebral height recovery rate,and improvement rate of postoperative Cobb angle were the risk factors for postoperative residual pain.Corresponding preventive measures should be taken in clinical work to reduce the occurrence of postoperative residual pain.