摘要
目的分析椎体后凸成形术(PKP)治疗老年胸腰椎压缩性骨折患者的临床疗效及影响术后再骨折的危险因素。方法回顾性分析江苏省如皋市人民医院骨科2016年4月-2018年7月行PKP手术治疗的198例胸腰椎体压缩性骨折老年患者,男性74例,女性124例;年龄60~87岁,平均74.2岁。依据术后是否出现新发骨折将患者分为再骨折组(35例)和对照组(163例)。采用调查问卷及查阅临床资料相结合的方式,分析不同特征人群的术后再骨折情况,并通过多因素Logistic回归分析影响术后再骨折的因素。结果198例老年胸腰椎压缩性骨折患者均顺利完成PKP,术后1周患者VAS评分和ODI指数较治疗前显著降低[(2.5±1.2)分vs.(7.0±1.7)分,(21.9±8.7)%vs.(62.8±11.2)%,均P<0.05],术后18例(9.1%)患者出现骨水泥渗漏,无感染、出血、气胸等并发症。随访6~12个月,35例(17.7%)患者发生新发骨折,其中19例(54.3%)属相邻椎体骨折;单因素分析初步筛选出了5个与术后再骨折有关的危险因素(年龄、伤椎数、骨折病史、骨密度、手术椎体数);多因素Logistic回归分析显示年龄(OR=6.781)、手术椎体数(OR=6.050)、骨密度(OR=10.334)及伤椎数(OR=9.137)为术后再骨折的危险因素。结论年龄、手术椎体数、骨密度、伤椎数等均为PKP术后再骨折的危险因素。
Objective To analyze the clinical effect of percutaneous kyphoplasty(PKP)for elderly patients with compression fractures of the thoracic and lumbar vertebrae and analysis of risk factors influencing postoperative refracture.Methods A total of 198 patients with thoracolumbar compression fractures treated with PKP in our hospital from Apr.2016 to Jul.2018 were selected.There were 74 males and 124 females,with an average age of 74.2 years(60-87 years).Patients were divided into re-fracture group(35 cases)and control group(163 cases)according to whether new fractures occurred after surgery.Combined with questionnaires and clinical data,the postoperative refracture status of different characteristics was analyzed,and the influencing factors of postoperative re-fracture were analyzed by multivariate Logistic regression.Results All the 198 elderly patients with thoracolumbar compression fractures successfully completed PKP,and the VAS scores and ODI of the patients after the surgery were significantly lower than before treatment[(2.5±1.2)vs.(7.0±1.7);(21.9±8.7)%vs.(62.8±11.2)%,all P<0.05],and cement leakage was found in 18 patients(9.1%)after surgery,but there was no infection,bleeding,pneumothorax or other complications.After 6 to 12 months of follow-up,35 patients(17.7%)had new fractures,among which 19(54.3%)were adjacent vertebral fractures.Single-factor analysis preliminarily screened out 5 risk factors related to postoperative re-fracture(age,number of injured vertebrae,history of fracture,bone density,number of operating vertebrae).Multivariate Logistic regression analysis showed that age(OR=6.781),number of operating vertebrae(OR=6.050),bone mineral density(OR=10.334)and number of injured vertebrae(OR=9.137)were risk factors for postoperative re-fracture.Conclusion Age,number of operating vertebrae,bone density,number of injured vertebrae are all risk factors for re-fracture after PKP.
作者
王亮亮
黄成
戴永平
卢弘栩
丁健
叶金标
WANG Liang-liang;HUANG Cheng;DAI Yong-ping;LU Hong-xu;DING Jian;YE Jin-biao(Department of Orthopaedics,Rugao people s Hospital,Rugao,Jiangsu 226500,China;Department of Orthopaedics,Huaian Hospital,Huaian,Jiangsu 223200,China)
出处
《创伤外科杂志》
2020年第5期340-344,共5页
Journal of Traumatic Surgery
基金
国家卫计委医药卫生科技发展研究中心资助课题(W2014ZT046)
南通市青年医学人才科研基金立项课题(指导性)(WQZ2015010)。
