Related factors affecting kyphotic reduction in osteoporotic vertebral compression fractures by percutaneous balloon kyphoplasty
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摘要:
目的 探讨影响椎体后凸成形术对骨质疏松性椎体压缩骨折(OVCF)患者后凸畸形改善的相关因素。 方法 回顾性分析2019年3月—2021年1月阜阳市人民医院接受PKP治疗的OVCF患者资料。本组患者接受PKP术结合体位复位治疗。纳入性别、年龄、体重指数、骨密度、伤椎节段、伤椎高度、骨折病程、局部后凸Cobb角度等指标，采用相关性分析及多元线性回归分析研究影响局部后凸畸形改善的相关因素，并判断对术后Cobb角改善预测效果。 结果 术前、术后及末次随访时局部后凸Cobb角、VAS评分、ODI评分差异均有统计学意义(均P<0.001)。患者术后局部后凸Cobb角[(10.9±7.4)°]与术前局部后凸Cobb角[(15.0±7.6)°]比较差异有统计学意义(P<0.05)，术后VAS评分及ODI评分与术前相比均明显改善(均P<0.05)。伤椎高度值(术前)、骨密度、骨折病程与术后后凸畸形改善呈负相关关系(r=-7.523、-3.406、-0.489, 均P<0.05)，局部后凸Cobb角(术前)与术后后凸畸形改善呈正相关关系(r=0.141, P<0.05)。多元线性回归分析显示后凸Cobb角改善=5.016-3.406×骨密度-7.523×伤椎高度值(术前)+0.141×局部后凸Cobb角(术前)-0.489×伤椎骨折病程。 结论 PKP术后后凸畸形改善与术前局部后凸Cobb角、伤椎高度、骨密度、骨折病程存在相关性，与术前局部后凸Cobb角呈正相关关系，与骨折病程、骨密度以及伤椎高度呈负相关关系。 Abstract:Objective To investigate the relevant factors influencing the improvement of local kyphotic deformity in individuals afflicted with osteoporotic vertebral compression fractures (OVCF) following percutaneous kyphoplasty (PKP) combined with positional reduction intervention. Methods The data of OVCF patients treated with PKP in Fuyang People' s Hospital from March 2019 to January 2021 were retrospectively analyzed. Patients were treated with PKP procedure combined with postural repositioning. Independent variables included gender, age, body mass index, bone mineral density, vertebral segments, vertebral height, fracture duration, and local kyphotic Cobb angle. Correlation analysis and multiple linear regression analysis were employed to discern the factors impacting the enhancement of local kyphotic deformity and to evaluate the predictive efficacy regarding postoperative Cobb angle improvement. Results Statistically significant differences were observed in the local kyphosis cobb angle, VAS score and Oswestry dability index(ODI) scores at the preoperative, postoperative and last follow-up (all P<0.001). There was a significant difference between the postoperative local kyphosis Cobb angle [(10.9±7.4) °] and the preoperative angle [(15.0±7.6) °, P<0.05]. Postoperative VAS and ODI scores showed significant improvement compared to the preoperative scores (all P<0.05). Preoperative vertebral height, bone density, and fracture duration were negatively correlated with the improvement of kyphotic deformity (r=-7.523, -3.406, -0.489, all P<0.05). The local kyphosis Cobb angle (preoperative) was positively correlated with the improvement of postoperative kyphosis deformity (r=0.141, P<0.05), multiple linear regression analysis showed improvement of kyphosis Cobb angle = 5.016-3.406×bone density-7.523×injured vertebral height value (preoperative) + 0.141×local kyphosis Cobb angle (preoperative) -0.489×course of injured vertebral fracture. Conclusion The improvement of kyphosis after PKP is correlated with the preoperative local kyphosis Cobb angle, the height of injured vertebra, bone density, and fracture course, positively correlates with the preoperative local kyphosis Cobb angle, and negatively correlates with the course of fracture, bone density and injured vertebra height. -
Key words:
- Percutaneous kyphoplasty /
- Vertebral compression fractures /
- Kyphosis /
- Osteoporosis /
- Bone density
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图 1 伤椎椎体高度值及局部后凸角测量
注：a1为上位椎体前柱高度，m1为上位椎体中柱高度，a0为伤椎椎体前柱高度，m0为伤椎椎体中柱高度，a2为下位椎体前柱高度，m2为下位椎体中柱高度，伤椎椎体高度值H=(a0+m0)/[(a1+a2+m1+m2)/2]×100%。
Figure 1. The measurement of vertebral body height and local kyphotic cobb angle of fractured vertebra
表 1 OVCF患者术前、术后及末次随访时局部后凸Cobb角、VAS评分、ODI评分比较(x±s)
Table 1. Comparison of local kyphotic Cobb Angle, VAS score and ODI score in OVCF patients before, after surgeryand at the last follow-up (x±s)
项目 术前 术后 末次随访 F值 P值 局部后凸Cobb角(°) 15.0±7.6 10.9±7.4a 10.5±5.5a 8.473 <0.001 VAS评分(分) 7.8±1.0 3.0±0.9a 2.0±0.6ab 863.900 <0.001 ODI评分(%) 73.2±4.9 20.8±3.8a 17.9±4.1a 3 419.000 <0.001 注：与术前比较，aP<0.05；与术后比较，bP<0.05。 
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表 2 Cobb角改善影响因素的相关性分析
Table 2. Correlation analysis of influencing factors of Cobb Angle improvement
项目 r值 P值 性别 -0.032 0.172 年龄 0.054 0.225 骨密度 -3.406 0.019 BMI 0.048 0.635 骨折病程 -0.489 0.036 骨折节段 0.587 0.327 术前椎体高度 -7.523 0.012 术前局部后凸Cobb角 0.141 ＜0.001 骨水泥渗漏 0.575 0.652
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表 3 局部后凸Cobb角改善的多元线性回归分析
Table 3. Multiple linear regression analysis of local kyphotic Cobb Angle improvement
变量 B SE β t值 P值 骨密度 -3.406 1.023 -0.271 -3.187 0.002 术前伤椎高度 -7.523 2.399 -0.259 -3.136 0.003 术前局部后凸Cobb角 0.141 0.048 0.243 2.945 0.005 伤椎骨折时间 -0.489 0.077 -0.541 -6.363 <0.001
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