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胸腰椎骨质疏松性压缩骨折患者经皮椎体后凸成形术后残留腰背部疼痛的影响因素分析

Analysis of influencing factors of residual low back pain in thoracolumbar osteoporotic vertebral compression fracture after percutaneous kyphoplasty
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摘要 目的分析胸腰椎骨质疏松性压缩骨折(OVCF)患者经皮椎体后凸成形术(PKP)后残留腰背部疼痛的影响因素。方法选取2019年1月至2022年12月在我院择期行PKP的胸腰椎OVCF患者97例,术后随访1个月,根据是否存在残留腰背部疼痛[视觉模拟评分(VAS)>4分]分为疼痛组(n=15)和无痛组(n=82)。比较两组手术前后VAS评分,收集患者临床资料,分析胸腰椎OVCF患者行PKP后残留腰背部疼痛的影响因素。结果末次随访时97例患者VAS>4分有15例(15.46%),VAS≤4分有82例(84.54%)。术后12 h、1周和1个月两组VAS评分较术前均降低(P<0.05),且术后1周、1个月疼痛组VAS评分显著高于无痛组(P<0.05)。单因素Logistic回归分析显示,体质量指数、筋膜损伤、手术入路方式、单个椎体骨水泥注入量、骨水泥渗漏情况、术后椎体高度恢复率和术前骨密度等均为影响胸腰椎OVCF患者行PKP后残留腰背部疼痛的影响因素(P<0.05);多因素Logistic回归分析显示,有筋膜损伤、有骨水泥渗漏和术前骨密度<-3.10均为影响胸腰椎OVCF患者行PKP后残留腰背部疼痛的独立危险因素(P<0.05)。结论PKP治疗胸腰椎OVCF仍有部分患者存在残留腰背部疼痛,与筋膜损伤、骨水泥渗漏和术前骨密度<-3.10有关,临床应采取积极有效的针对性措施来降低残留腰背部疼痛发生率,改善预后。 Objective To analyze the influencing factors of residual lumboback pain after percutaneous kyphoplasty(PKP)for thoracolumbar osteoporotic compression fracture(OVCF).Methods A total of 97 patients with thoracolumbar OVCF undergoing elective PKP in our hospital were enrolled between January 2019 and December 2022.All patients were followed up for 1 month after surgery.According to presence or absence of residual low back pain based on score of visual analogue scale(VAS)>4 points,they were divided into a pain group(n=15)and a painless group(n=82).The VAS scores before and after operation were compared between the two groups.The clinical data of patients were collected.The influencing factors of residual low back pain were analyzed.Results At the last follow-up,15(15.46%)patients had VAS>4 points,and 82(84.54%)had VAS≤4 points.The VAS score of both groups was decreased after 12 hours,1 week and 1 month of surgery(P<0.05),and the VAS score of the painless group after 1 week and 1 month of surgery was significantly lower than that of the pain group(P<0.05).Univariate logistic regression analysis showed that body mass index,fascia injury,surgical approach,individual vertebral cement injection,cement leakage,postoperative vertebral height recovery rate and preoperative bone mineral density were associated with residual lumbago pain in thoracolumbar OVCF patients after PKP(P<0.05).Multivariate Logistic regression analysis showed that fascia injury,bone cement leakage and preoperative bone mineral density<-3.10 were independent risk factors of residual low back pain in patients with thoracollumbar OVCF after PKP(P<0.05).Conclusions There is still residual low back pain in some patients with thoracollumbar OVCF after PKP.It is related to fascia injury,bone cement leakage and preoperative bone mineral density<-3.10.Clinically,active and effective targeted measures should be taken to reduce the incidence of residual low back pain and improve their prognosis.
作者 戚文元 缪世昌 孙丽萍 QI Wen-yuan;MIAO Shi-chang;SUN Li-ping(Department of Orthopaedics,Jiangyin Affiliated Hospital of Nanjing University of Traditional Chinese Medicine,Jiangyin 214400,China)
出处 《实用医院临床杂志》 2024年第2期115-119,共5页 Practical Journal of Clinical Medicine
基金 无锡市中医药管理局科研基金资助项目(编号:ZYKJ201919)。
关键词 胸腰椎骨质疏松性压缩骨折 经皮椎体后凸成形术 残留腰背部疼痛 危险因素 Thoracolumbar osteoporotic vertebral compression fracture Percutaneous kyphoplasty Residual low back pain Risk factor
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