影响椎体后凸成形术椎体高度恢复的相关因素及临床意义

目的探讨经皮椎体后凸成形术（percutaneous kyphoplasty,PKP）治疗老年骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fracture,OCVF）,影响椎体高度恢复的相关因素及临床意义。方法总结2010年9月至2011年3月间应用经皮椎体后凸成形技术（PKP）治疗老年新鲜骨质疏松性单椎体压缩骨折的病例资料32例,对比术前与术后椎体高度恢复的影像学变化,计算伤椎高度的平均恢复率,将恢复率高于和低于平均值的病例分为两组,分别记录各组患者的年龄,病程,骨密度,术前伤椎高度,术前局部Cobb角以及骨水泥注入量等相关因素;应用独立样本T检验进行组间单因素分析,将具有统计学差异的单因素引入多元线性回归分析,探讨影响椎体后凸成形术后椎体高度恢复的相关因素及临床意义。结果术后全部患者视觉疼痛评分（VAS）和Oswestry功能障碍指数均有明显改善（P〈0.05）,伤椎高度的平均恢复率为48.91±0.78%;单因素分析显示病程,骨密度和术前伤椎高度三个因素在两组间比较差异有显著性（P〈0.001）;多因素分析显示术前伤椎高度和骨密度是影响伤椎高度恢复的主要因素,其标准化回归系数分别为0.464和-0.377。结论椎体后凸成形术可以有效的恢复压缩椎体的高度,平均高度恢复率为48.91±0.78%;伤椎恢复高度的程度与患者术前伤椎高度和骨密度关系密切,可以作为预测术后伤椎高度恢复程度的有效指标。

Clinical significance and correlation factors on the vertebral height restoration of percutaneous kyphoplasty

Objective To investigate the clinical significance and correlative factors on the vertebral height restoration of percutaneous kyphoplasty in treating elderly osteoporotic vertebral compression fracture.Methods From September 2010 to March 2011,32 consecutive patients with osteoporotic vertebral compression fracture were treated with single level percutaneous vertebral kyphoplasty and were retrospectively analyzed.The average vertebral height restoration rate was calculated through comparing the imaging change between pre- and post kyphoplasty.The patients were divided into two groups according to the restoration rate above（group A） or below（group B） the average rate.The possible correlative factors including age,disease course,bone mineral density,preoperative vertebral height,preoperative local Cobb＇s angle and cement volume were recorded respectively.Independent-samples T test analysis was used to find the possible factors affecting vertebral height restoration.Multiple linear regression analysis was used to find the most correlative factor and investigate the clinical significance.Results All the cases had rapid and significant improvement in VAS and ODI score following kyphoplasty（P0.05）.Average vertebral height restoration rate was 48.91±0.78%;Independent-samples T test analysis revealed that disease course,bone mineral density and preoperative vertebral height were related with vertebral height restoration（P〈0.001）.Multiple linear regression analysis showed that preoperative vertebral height and bone mineral density are the main corresponding factors.The standardized regression coefficient was 0.464 and -0.377.Conclusion Balloon Kyphoplasty is a reliable and effective method for elderly osteoporotic vertebral compression fracture.The average vertebral height restoration rate is 48.91±0.78%.Preoperative vertebral height,bone mineral density and disease course had effect on vertebral height restoration.Preoperative vertebral height and bone mineral density can be used as effective factors to predict the degree of vertebral height restoration of percutaneous kyphoplasty.