椎体成形术治疗老年椎体压缩性骨折疗效的影响因素分析

Analysis of influencing factors of vertebroplasty in the treatment of senile vertebral compression fracture

目的分析影响椎体成形术治疗老年椎体压缩性骨折疗效的相关因素,以期预估患者术后疗效,必要时提前干预以提高治疗有效率。方法回顾性纳入2015年1月-2022年6月在六安市人民医院骨科住院并接受椎体成形术治疗的老年椎体压缩性骨折患者307例。根据日本矫形外科协会评分(JOA评分)改善率将患者分为有效组(257例)和无效组(50例)。从性别、年龄、手术方式、血清Mg^(2+)浓度、骨水泥累及上下终板、骨水泥形态、骨水泥部位、骨水泥覆盖骨折线和水肿区、骨质疏松、陈旧性骨折进行归纳分析。使用多因素非条件logistic回归分析研究影响疗效的相关因素。结果2组骨水泥未累及上下终板、骨水泥为“O”型、骨水泥分布于椎体后2/3位置、骨水泥未覆盖骨折线和水肿区、骨质疏松例数比较差异有统计学意义(均P<0.05),而2组性别、年龄、血清Mg^(2+)浓度是否降低、是否为陈旧性骨折差异无统计学意义(均P>0.05),且骨水泥未累及上下终板(OR=9.188,P=0.034)、骨水泥为“O”型(OR=29.274,P<0.001)、骨水泥分布于椎体后2/3位置(OR=24.928,P=0.001)、骨水泥未覆盖骨折线和水肿区(OR=16.357,P=0.045)为影响其疗效的独立危险因素。结论骨水泥未累及上下终板、骨水泥为“O”型、骨水泥分布于椎体后2/3位置、骨水泥未覆盖骨折线和水肿区均为影响疗效的独立危险因素。

Objective To analyze the factors affecting the effect of vertebroplasty on senile vertebral compression fracture,in order to estimate the postoperative efficacy of patients and intervene in advance if necessary to improve the effectiveness of treatment.Methods A retrospective study was conducted on 307 elderly patients with vertebral compression fracture who were admitted to the Department of Orthopedics of Lu'an People's Hospital from January 2015 to June 2022 and received vertebroplasty.Patients were divided into effective group(n=257)and ineffective group(n=50)according to the improvement rate of the Japanese Orthopaedic Association score(JOA score).Gender,age,surgical methods,serum Mg^(2+)concentration,bone cement touch the upper and lower endplates,shape of bone cement,part of bone cement,bone cement covering fracture line and edema area,osteoporosis,and old fracture were summarized and analyzed.Multivariate logistic regression was used to analyze the related factors affecting the curative effect.Results There was a positive correlation between cement not involving the upper and lower endplates,cement being"O"shaped,cement being distributed in the posterior 2/3 of the vertebral body,cement not covering the fracture line and oedema area,and osteoporosis and poor efficacy of vertebral compression fractures treated with vertebroplasty,and the differences were statistically significant(all P<0.05).There were no significant differences of gender,age,decrease in serum Mg^(2+)concentration,old fracture or not(all P>0.05).Cement not involving the upper and lower endplates(OR=9.188,P=0.034),cement being"O"shaped(OR=29.274,P<0.001),cement being distributed in the posterior 2/3 of the vertebral body(OR=24.928,P=0.001),and cement not covering the fracture line and oedema area(OR=16.357,P=0.045)were independent risk factors affecting their efficacy.Conclusion Bone cement don't touch the upper and lower endplates,"O"type of bone cement,distribution of bone cement in the posterior 2/3 of the centrum,and the failure of bone cement to cover the fracture line and edema area are independent risk factors for therapeutic effect.