骨质疏松性腰椎压缩骨折经皮椎体成形术后残留腰背痛的相关因素分析

Analysis of relevant factors of residual low back pain after percutaneous vertebroplasty of osteoporotic lumbar compression fractures

目的分析骨质疏松性腰椎压缩骨折经皮椎体成形术后残留腰背痛的相关危险因素。方法纳入自2019-07—2022-07采用经皮椎体成形术治疗的150例骨质疏松性腰椎压缩骨折,按照手术疗效分为两组,其中满意组(术后1个月疼痛VAS评分<3分)136例,不满意组(术后1个月疼痛VAS评分≥3分)14例,收集两组患者的临床资料并纳入单因素分析和多因素Logistic回归分析。结果所有患者均获得随访,随访时间1~2年,平均1.2年。150例术后残留腰背痛14例,残留腰背痛发生率为9.33%。单因素分析结果显示满意组与不满意组性别、年龄差异无统计学意义(P>0.05),两组体质量指数、骨密度、术前腰背肌筋膜损伤情况、术前有无椎体内裂隙征、有无合并脊柱退行性疾病,以及骨水泥注入量、骨水泥弥散情况、椎体前缘压缩矫正度数、脊柱后凸角矫正度数差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示术前骨密度低、腰背肌筋膜损伤、合并椎体内裂隙征、脊柱退行性疾病及骨水泥弥散不满意、脊柱后凸畸形矫正差是骨质疏松性腰椎压缩骨折经皮椎体成形术后残留腰背痛的独立危险因素。结论骨质疏松性腰椎压缩骨折经皮椎体成形术后残留腰背痛与术前骨密度低、腰背肌筋膜损伤、合并椎体内裂隙征、脊柱退行性疾病及骨水泥弥散不满意、脊柱后凸畸形矫正差有关。

Objective To analyze the risk factors associated with residual low back pain after percutaneous vertebroplasty of osteoporotic lumbar compression fractures.Methods One hundred and fifty cases of osteoporotic lumbar compression fractures treated by percutaneous vertebroplasty from July 2019 to July 2022 were enrolled,and they were divided into two groups according to the surgical efficacy,including 136 cases in the satisfactory group(pain VAS score<3 points at one month postoperatively)and 14 cases in the unsatisfactory group(pain VAS score≥3 points at one month postoperatively).The univariate and multivariate logistic regression analysis were used to identify the risk factors for residual low back pain after PVP.Results All patients were followed up for 1-2 years,with an average of 1.2 years.There were 14 cases of postoperative residual low back pain in 150 cases,and the incidence rate of residual low back pain was 9.33%.Univariate analysis showed that there was no significant difference in gender and age between the satisfactory and unsatisfactory groups(P>0.05),but there were significant differences in body mass index,bone mineral density,preoperative lumbar back myofascial injury,preoperative intravertebral fissure sign,and whether there were spinal degenerative diseases,as well as the amount of cement injected,the diffusion of cement,the degree of compression correction of the anterior edge of the vertebral body,and the degree of correction of kyphosis angle between the two groups(P<0.05).Multivariate Logistic regression analysis showed that low bone mineral density before surgery,low back myofascial injury,combined with intravertebral fissures,spinal degenerative diseases and unsatisfactory diffusion of bone cement,and poor correction of kyphotic deformity were independent risk factors for residual low back pain after percutaneous vertebroplasty of osteoporotic lumbar vertebroplasty.Conclusion Residual low back pain after percutaneous vertebroplasty of osteoporotic lumbar compression fracture is associated with low bone mineral density before surgery,low back myofascial injury,combined with intravertebral fissure sign,spinal degenerative diseases and unsatisfactory diffusion of bone cement,and poor correction of kyphotic deformity.