椎体强化术治疗超高龄患者骨质疏松性椎体压缩性骨折的临床疗效和生存质量分析

Clinical efficacy and quality of life in super-elderly patients with osteoporotic vertebral compression fractures after vertebral augmentation

目的比较椎体强化术与非手术治疗对超高龄骨质疏松性椎体压缩性骨折(OVCFs)患者的临床疗效和生存质量,为其合理治疗提供临床数据。方法前瞻性研究2022年1月—2023年3月在西南医科大学附属医院和四川省人民医院德阳医院接受椎体强化术治疗和非手术治疗的62例(男性20例,女性42例;年龄85~98岁,平均88.2岁;跌倒伤35例,重物砸伤11例,道路交通伤7例,其他9例)超高龄OVCFs患者,根据治疗方式分为手术组(接受椎体强化术治疗的患者)和非手术组(接受非手术治疗的患者)。比较两组患者的基线资料和治疗前、治疗后1周、3个月及末次随访的腰背部VAS;同时采用Odom标准评估两组患者的临床疗效。生存质量分析则采用治疗前和末次随访时SF-36生活质量量表(SF-36)生理健康总分(PCS)和心理健康总分(MCS)进行比较。利用Pearson或Spearman相关分析方法分析影响两组患者生存质量的相关因素。结果患者均完成随访,无失访、死亡等情况,随访12~18个月,平均14.2个月。手术组39例,非手术组23例,两组患者基线资料比较无统计学差异(P>0.05)。手术组发生2例并发症,非手术组发生6例并发症(P<0.05)。手术组治疗后1周、3个月、末次随访的Odom’s分级优良率均高于非手术组(97.4%,92.3%,94.8%vs.39.1%,60.9%,86.9%)。两组患者治疗后各随访时间点的VAS和末次随访的SF-36量表PCS得分均较治疗前明显改善(P<0.05);手术组各随访时间点VAS显著低于非手术组[治疗后1周3(3,4)vs.5(4,6)、治疗3个月2(2,3)vs.3(3,4)、末次随访2(1,2)vs.3(2,3)];手术组末次随访SF-36量表的PCS(48.1±2.0 vs.28.7±1.7)、MCS(57.8±1.9 vs.38.2±2.2)得分明显高于非手术组(P<0.05)。相关性分析显示在两组中,患者的年龄、骨折椎体数量、治疗前腰背部疼痛VAS与患者末次随访的SF-36量表评分负相关,骨密度T值、治疗前SF-36量表PCS、MCS得分与患者末次随访的SF-36量表得分正相关。结论椎体强化术能快速缓解超高龄患者OVCFs疼痛,明显提高患者生存质量,降低长期卧床并发症发生率。患者的年龄、骨质状况、骨折椎体数量、伤后VAS及治疗前的生存质量是超高龄OVCFs患者生存质量的重要影响因素。

To compare the clinical efficacy and quality of life(QoL)in super-elderly patients with osteoporotic vertebral compression fractures(OVCFs)managed by vertebral augmentation or conservative treatment,and to provide clinical data and reference for more reasonable management of OVCFs in elder patients.Methods This prospective study was conducted on 62 OVCF patients aged 85-98(mean 88.2)years and treated at the Affiliated Hospital of Southwest Medical University&Sichuan Provincial People’s Deyang Hospital from Jan.2022 to Mar.2023 by vertebral augmentation or conservative treatment.There were 20 males and 42 females,who were divided into surgery group(vertebral augmentation,n=39)and non-surgery group(conservative treatment,n=23).The baseline data and lower back pain by VAS before,1 week and 3 months after treatment and at last follow-up were recorded.The Odom criteria was used to evaluate the clinical efficacy of the two groups;while the QoL was evaluated by using the 36-item short-form survey(SF-36),including the physical component score(PCS),mental component score(MCS)and total score.Pearson or Spearman correlation analysis was used to analyze factors affecting the QoL.Results All patients were followed up for 12-18(mean 14.2)months without loss of follow-up or death.The baseline data showed no significant difference between the two groups(P>0.05).Two cases of complications were reported in the surgical group and 6 in the non-surgery group(P<0.05).The excellent and good rate by Odom criteria was higher in the surgery group than in the non-surgery group at 1 week(97.4%vs.39.1%),3 months(92.3%vs.60.9%)and last follow-up(94.8%vs.86.9%).Compared with before treatment,the VAS at each follow-up time point and the PCS,MCS and total score of SF-36 at the last follow-up were significantly improved in both groups(all P<0.05).Moreover,the surgery group revealed much lower VAS at each follow-up time point1 week after treatment:3(3,4)vs.5(4,6);3 months after treatment:2(2,3)vs.3(3,4);last follow-up:2(1,2)vs.3(2,3),and better SF-36 outcomes at last follow-up(PCS 48.1±2.0 vs.28.7±1.7,MCS 57.8±1.9 vs.38.2±2.2),compared with the non-surgery group(all P<0.05).Correlation analysis showed that age,number of fractured vertebrae,and VAS of the lower back before treatment were negatively correlated with SF-36 score at the last follow-up,while the T value of bone mineral density and PCS and MCS of SF-36 before treatment were positively correlated with SF-36 score.Conclusion Vertebral augmentation can quickly relieve pain,improve QoL and reduce complications in super-elderly OVCF patients.Age,bone status,number of fractured vertebrae,VAS after injury and QoL before treatment are important factors affecting the QoL of such patients.