终板缺损和椎体后壁损伤对骨质疏松性椎体骨折PKP术后疼痛和影像学参数的预测价值

The predictive value of endplate defect and posterior vertebral wall injury on pain and imaging parameters after PKP surgery for osteoporotic vertebral fractures

目的探讨终板缺损和椎体后壁损伤对骨质疏松性椎体压缩骨折(OVCF)患者行球囊后凸成形术(PKP)术后疼痛、功能障碍及影像学参数的影响。方法选择2019年1月至2020年12月在该院就诊的133例腰椎单节段OVCF患者作为研究对象,根据术前MRI椎体骨折程度,将患者分为无上终板骨折(NEF组)、上终板前部骨折(EF1组)、上终板后部骨折(EF2组)、完全上终板骨折(EF3组)。根据术前CT证实是否存在椎体后壁损伤,将患者分为后壁损伤和非后壁损伤组。观察不同分组患者术前、术后、术后6个月时的VAS评分和影像学参数变化。结果133例患者术后和术后6个月的VAS、Cobb角均较术前显著降低,伤椎前缘高度均高于术前(P<0.05)。术后和术后6个月时,EF3组患者Cobb角高于NEF、EF1和EF2组(P<0.05)。术后6个月时,EF2和EF3组患者椎体高度恢复率低于NEF和EF1组(P<0.05);术后6个月时,EF3组后凸角矫正度低于NEF、EF1和EF2组(P<0.05);EF1、EF2和EF3组骨水泥渗漏率差异均高于NEF组(P<0.05)。有无后壁损伤患者的术前、术后、术后6个月时VAS、伤椎前缘高度、Cobb角、椎体高度恢复率、后凸角矫正度、骨水泥渗漏率差异均无统计学意义(P>0.05)。结论终板损伤和后壁损伤不会影响PKP术后疼痛程度,但终板损伤会影响术后椎体高度、脊柱后凸、骨水泥渗漏的发生。

Objective To investigate the effects of endplate injury and posterior wall injury on pain,dysfunction and imaging parameters after balloon kyphoplasty(PKP)for osteoporotic vertebral compression fractures(OVCF).Methods 133 patients with lumbar single segment OVCF who were treated in our hospital from January 2019 to December 2020 were selected as the study objects.According to the degree of vertebral fracture on MRI before operation,the patients were divided into three groups:no upper endplate fracture group(NEF group),anterior upper endplate fracture group(EF1 group),posterior upper endplate fracture group(EF2 group),and complete upper endplate fracture group.The patients were divided into posterior wall injury group and non posterior wall injury group according to the CT findings.The changes of VAS score and imaging parameters were observed before,after and 6 months after operation in different groups of patients.Results The VAS and Cobb angle of 133 patients after operation and 6 months after operation were significantly lower than those before operation,and the height of the injured vertebral front edge was higher after operation and 6 months after operation than that before operation(P<0.05).Cobb angle in EF3 group was higher than that in NEF,EF1 and EF2 groups after operation and 6 months after operation(P<0.05).At 6 months after operation,the recovery rate of vertebral height in EF2 and EF3 groups was lower than that in NEF and EF1 groups(P<0.05).At 6 months after operation,the correction angle of kyphosis in EF3 group was lower than that in NEF,EF1 and EF2 groups(P<0.05).The bone cement leakage rate in EF1,EF2 and EF3 groups was higher than that in NEF group(P<0.05).The bone cement leakage rate in EF1,EF2 and EF3 groups was higher than that in NEF group(P<0.05).There was no significant difference in VAS,anterior vertebral height,Cobb Angle,vertebral height recovery rate,kyphosis Angle correction rate and bone cement leakage rate between patients with and without posterior wall injury before operation,after operation and 6 months after operation(P>0.05).Conclusion End plate injury and posterior wall injury will not affect the degree of pain after PKP,but will affect the vertebral height,kyphosis and bone cement infiltration after PKP.