胸腰椎骨折患者经皮穿刺椎体成形术后急性疼痛发展轨迹及其影响因素分析

郑勇红; 郑明军; 冯法博

doi:10.16766/j.cnki.issn.1674-4152.003876

胸腰椎骨折患者经皮穿刺椎体成形术后急性疼痛发展轨迹及其影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.003876

1.
淳安县第一人民医院(浙江省人民医院淳安分院)骨科，浙江杭州 311700
2.
浙江省人民医院骨科，浙江杭州 310014

基金项目:

浙江省医药卫生科技计划项目 2024KY664

详细信息

通讯作者:
郑明军，E-mail：593269738@qq.com

中图分类号: R683.2
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- 文章访问数: 12
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- 被引次数: 0
出版历程
- 收稿日期: 2024-01-22
- 网络出版日期: 2025-03-27

Analysis of the progression and factors influencing postoperative acute pain in patients with thoracolumbar fracture

1.
Department of Orthopedics, Chun ' an Branch of Zhejiang Provincial People' s Hospital, Hangzhou, Zhejiang 311700, China

摘要

摘要: 目的分析胸腰椎骨折患者术后急性疼痛发展的状况, 采用潜在剖面分析术后急性疼痛的异质性, 并探讨影响不同急性疼痛进展分型的相关因素。方法选取2020年4月-2023年9月于浙江省人民医院淳安分院接受经皮穿刺椎体成形术(PVP)治疗的180例胸腰椎骨折术后患者为研究对象。采用一般资料调查表、视觉模拟疼痛评分量表对患者进行调查。对胸腰椎骨折术后患者急性疼痛进行潜在剖面分析, 并通过多元有序logistic回归分析研究影响胸腰椎骨折患者术后急性疼痛的因素。结果胸腰椎骨折术后患者急性疼痛进展得分为(6.78±1.13)分; 当类别数目为3时, AIC、BIC、aBIC下降趋于平缓, LMRT的P值>0.001, 故选取3个潜在剖面, 分别为轻度疼痛(35.54%)、中度疼痛(43.98%)、重度疼痛(20.48%); 重度疼痛患者BMI>24、骨折椎体个数>2个、骨水泥分布不满意、椎体恢复高度高、骨折部位在腰椎患者的占比显著高于轻度疼痛组和中度疼痛组(P < 0.05)。多因素logistic分析显示, 骨折椎体个数>2个、BMI≥24、骨水泥分布不满意、骨折部位在腰椎、椎体恢复高度高均为胸腰椎骨折术后重度疼痛的危险因素(P < 0.05)。结论胸腰椎骨折术后患者急性疼痛进展水平偏高, 且存在异质性; 其中骨折椎体>2个、BMI≥24、骨水泥分布不满意、骨折部位在腰椎以及椎体恢复高度高是胸腰椎骨折术后患者重度疼痛的危险因素。
- 胸腰椎骨折 /
- 经皮穿刺椎体成形术 /
- 术后疼痛 /
- 发展轨迹 /
- 影响因素
Abstract: Objective This study aims to analyze the progression of postoperative acute pain in patients with thoracolumbar fracture, analyze the variability in postoperative acute pain profiles, and explore factors affecting the patterns of different acute pain progression. Methods From April 2020 to September 2023, a total of 180 postoperative patients with thoracolumbar fractures underwent percutaneous vertebro plasty (PVP) in Chun'an Branch of Zhejiang Provincial People's Hospital were enrolled in this study.These patients were assessed using a general information questionnaire and a visual analogue pain scale.The study analyzed the potential profiles of acute pain after thoracolumbar fracture and identified the factors affecting acute pain through multivariate ordered logistic regression. Results The mean score of acute pain after thoracolumbar fracture operation was (6.78±1.13) points.When the number of categories is 3, the decline in AIC, BIC, and aBIC became gradual, and the P-value of LMRT exceeded 0.001, indicating that three potential profiles are appropriate: mild pain (35.54%), moderate pain (43.98%), and severe pain (20.48%).Patients with severe pain had a significantly higher proportion of BMI≥24, more than two fractured vertebral bodies, unsatisfied bone cement distribution, concurrent osteoporosis, high vertebral body recovery, and lumbar spine fracture sites compared to those in the mild pain group and moderate pain group (P < 0.05).Multivariate logistic analysis showed that more than two fractured vertebral bodies, BMI≥24, unsatisfactory bone cement distribution, lumbar vertebrae fracture sites, and high vertebral body recovery were significant factors influencing severe pain after thoracolumbar fractures (P < 0.05). Conclusion The level of acute pain in patients with thoracolumbar fracture after operation is high and exhibits heterogeneity.Notably, factor such as fracture vertebral bodies>2, BMI≥24, unsatisfactory body cement distribution, lumbar vertebrae fracture sites, and vertebral body recovery are significant contributors to severe pain in patients with thoracolumbar fractures after operation.
- Thoracolumbar fracture /
- Percutaneous vertebro plasty /
- Postoperative pain /
- Progression /
- Influencing factors

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表 1 胸腰椎骨折术后患者疾病疼痛进展的潜在剖面分析拟合指标

Table 1. Fitting index of potential profile analysis of disease pain progress in patients with thoracolumbar fracture after operation

类别个数	AIC	BIC	aBIC	信息熵	LMRT(P值)	BLRT(P值)	类别概率(%)
1	1 798.133	1 814.550	1 795.586	0.982	< 0.001	< 0.001	100.00
2	1 694.158	1 786.327	1 675.315	0.824	< 0.001	< 0.001	44.57/55.43
3	1 617.362	1 695.384	1 691.348	0.815	< 0.001	< 0.001	35.54/43.98/20.48
4	1 686.348	1 805.327	1 711.957	0.818	0.251	< 0.001	23.49/17.47/39.16/19.88
5	1 718.093	1 854.384	1 775.947	0.821	0.342	< 0.001	16.87/18.67/25.90/16.27/22.29

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表 2 胸腰椎骨折术后患者急性疼痛3个潜在剖面类别归属概率矩阵

Table 2. Probability matrix of belonging to three potential profile categories for acute pain in patients after thoracolumbar fracture surgery

类型	归属潜在剖面类别概率(%)
类型	轻度疼痛型	中度疼痛型	重度疼痛型
轻度疼痛型	97.69	2.31	0
中度疼痛型	1.66	98.34	0
重度疼痛型	0	0.42	99.58

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表 3 不同潜在剖面类别胸腰椎骨折术后患者一般资料比较

Table 3. Comparison of general data of postoperative patients with thoracolumbar fractures in different potential profile categories

项目	轻度疼痛 (n=59)	中度疼痛 (n=73)	重度疼痛 (n=34)	统计量	P值
性别[例(%)]				0.315^a	0.854
男性	21(35.59)	29(39.73)	12(35.29)
女性	38(64.41)	44(60.27)	22(64.71)
年龄[例(%)]				2.763^a	0.598
50~60岁	29(49.15)	39(53.42)	19(55.88)
>60岁	30(51.85)	34(46.58)	15(44.12)
BMI[例(%)]				10.616^a	0.005
< 24	52(88.14)	65(89.04)	5(14.71)
≥24	7(11.86)	8(10.96)	29(85.29)
合并疾病[例(%)]
高血压	19(32.20)	25(34.25)	9(26.47)	2.428^a	0.297
冠心病	10(16.95)	17(23.29)	7(20.59)	1.279^a	0.528
其他	15(25.42)	24(32.88)	10(29.41)	1.666^a	0.435
骨折椎体个数[例(%)]				13.152^a	0.011
1个	37(62.71)	42(57.53)	12(35.29)
2个	14(23.73)	20(27.40)	8(23.53)
>2个	8(13.56)	11(15.07)	14(41.18)
骨水泥分布[例(%)]				16.601^a	< 0.001
满意	37(62.71)	41(56.16)	7(20.59)
不满意	22(37.29)	32(43.84)	27(79.41)
合并骨质疏松[例(%)]				2.047^a	0.359
是	24(40.68)	32(43.84)	10(29.41)
否	35(59.32)	41(56.16)	24(70.59)
椎体恢复高度(x±s，mm)	3.21±0.84	3.54±1.14	4.27±1.33	10.298^b	< 0.001
骨折部位[例(%)]				12.292^a	0.002
胸椎	37(62.71)	46(63.01)	15(44.12)
腰椎	22(37.29)	27(36.99)	19(55.88)
文化程度[例(%)]				1.317^a	0.518
初中及以下	27(45.76)	34(46.58)	12(35.29)
初中以上	32(54.24)	39(53.42)	22(64.71)
婚姻状况[例(%)]				6.328^a	0.176
未婚	19(32.20)	27(36.99)	10(29.41)
已婚	34(57.63)	40(54.79)	16(47.06)
丧偶或离异	6(10.17)	6(8.22)	8(23.53)
医疗费用[例(%)]				1.124^a	0.524
自费	21(35.59)	31(42.47)	11(32.35)
医保	38(64.41)	42(57.53)	23(67.65)
注：^a为χ²值，^b为F值。

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表 4 各变量赋值情况

Table 4. Variable assignment

变量	赋值方法
BMI	≥24=1，＜24=0
骨折椎体个数	>2个=1，≤2个=0
骨水泥分布	不满意=1，满意=0
椎体恢复高度	连续变量，以实际值赋值
骨折部位	腰椎=1，胸椎=0
疼痛程度	轻度=0，中度=1，重度=2

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表 5 胸腰椎骨折术后患者不同疼痛程度的影响因素

Table 5. Influencing factors of different pain degrees in patients with thoracolumbar fracture after operation

变量	B	SE	Waldχ²	P值	OR值	95% CI
BMI≥24	0.281	0.114	2.466	0.014	1.325	1.059~1.656
骨折椎体个数＞2个	0.746	0.232	10.318	0.001	2.108	1.337~3.324
骨水泥分布不满意	0.651	0.255	6.523	0.011	1.918	1.865~4.233
椎体恢复高度高	0.656	0.241	7.425	0.006	1.927	1.202~3.089
骨折部位在腰椎	0.529	0.212	2.499	0.012	1.698	1.121~2.571

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