经皮椎体后凸成形术治疗骨质疏松性压缩性骨折的临床效果及术后再骨折的影响因素

The clinical Effect of percutaneous Kyphoplasty for the Treatment of osteoporotic Compression Fractures and the influencing Factors of postoperative re Fractures

目的骨质疏松性椎体压缩性骨折(OVCF)患者采用经皮椎体后凸成形术(PKP)治疗的临床效果及术后再骨折的影响因素。方法选取2021年10月至2023年1月苏州市吴中区第二人民医院收治的OVCF患者142例,均接受PKP治疗,对其临床效果进行分析,比较术前、术后7 d伤椎Cobb角变化、疼痛程度、椎体骨折压缩程度,统计术后再骨折发生情况,并进行单因素与多因素Logistic回归分析以探索术后再骨折的影响因素。结果术后7 d疼痛视觉模拟评分法(VAS)评分、伤椎Cobb角、椎体骨折压缩程度较术前降低,差异有统计学意义(P<0.05);142例PKP治疗OVCF患者术后再骨折38例,发生率为26.76%。再骨折组年龄≥70岁、术前骨密度T值1.0~2.5 S、使用糖皮质激素、术前骨折椎体数≥2个的患者较未发骨折组占比更高,差异有统计学意义(P<0.05);多因素Logistic回归分析发现,年龄≥70岁(OR=2.657)、术前骨密度T值1.0~2.5 S(OR=4.024)、使用糖皮质激素(OR=5.137)、术前骨折椎体数≥2个(OR=3.276)是影响PKP治疗OVCF患者术后再骨折的独立危险因素,差异有统计学意义(P<0.05)。结论OVCF患者采用PKP治疗具有显著临床效果,能够减轻患者的疼痛程度,改善伤椎Cobb角、椎体骨折压缩,年龄、术前骨密度T值、糖皮质激素使用史及术前骨折椎体数均与再骨折发生存在密切关系。

Objective To investigate the clinical efficacy of percutaneous kyphoplasty(PKP)in the treatment of osteoporotic vertebral compression fractures(OVCF)and the influencing factors of postoperative fractures.Methods A total of 142 OVCF patients admitted to the Second People's Hospital of Wuzhong District,Suzhou City from October 2021 to January 2023 were selected,all of whom received PKP treatment.The clinical effects were analyzed,and the changes in Cobb angle,pain level,and compression degree of vertebral fractures before and 7 days after surgery were compared.The incidence of postoperative fractures was statistically analyzed,and univariate and multivariate Logistic regression analyses were conducted to explore the influencing factors of postoperative fractures.Results The visual analogue scale(VAS)score,Cobb angle of the injured vertebra,and degree of vertebral fracture compression were significantly lower 7 days after operation than that before operation,with statistical significance(P<0.05);The refracture group had a higher proportion of patients who were older than 70 years,had preoperative bone mineral density(BMD)T-values of 1.0~2.5 s,used glucocorticoid,and had more than 2 vertebrae before surgery than those in the non-fracture group,the difference was significant,and the difference was statistically significant(P<0.05);Multivariate logistic regression analysis found that age≥70 years old(OR=2.657),preoperative BMD T-value of 1.0~2.5 S(OR=4.024),use of glucocorticoids(OR=5.137),and preoperative number of fractured vertebral bodies≥2(OR=3.276)were independent risk factors(P<0.05)for postoperative refractures in OVCF patients treated with PKP.Conclusion PKP treatment for OVCF patients has a significant clinical effect,which can reduce the patient's pain level,improve the Cobb angle of the injured vertebra,vertebral fracture compression.age,preoperative BMD T-value,history of glucocorticoid use,and preoperative number of fractured vertebral bodies are closely related to the occurrence of refractures.