肌少症对经皮椎体强化术治疗骨质疏松性胸腰椎压缩骨折疗效的影响

【摘要】 目的：探讨肌少症对经皮椎体强化术（percutaneous vertebral augmentation，PVA）治疗骨质疏松性胸腰椎压缩骨折（osteoporotic thoracolumbar vertebral compression fracture，OTLVCF）疗效的影响。方法：回顾性分析2020年1月~2022年12月在空军军医大学第二附属医院和西安交通大学附属红会医院行PVA治疗的270例OTLVCF患者的临床资料，男性109例，女性161例；骨折椎体：T10 37例，T11 52例，T12 68例，L1 72例，L2 41例。依据欧洲老年人肌少症工作组（European Working Group on Sarcopenia in Older People，EWGSOP）的诊断标准，以男性优势手握力<28.0kg且L3水平骨骼肌指数（skeletal muscle index，SMI）<45.4cm2/m2、女性优势手握力<18.0kg且L3水平SMI<34.4cm2/m2作为诊断阈值，将患者分为肌少症组（52例）和非肌少症组（218例）。收集并记录两组患者的一般资料（性别、年龄、身高、体重、身体质量分数、骨折节段、握力和骨骼肌指数）、手术资料（手术方法、手术时间、术中出血量、骨水泥注入量和术中透视次数）和并发症（骨水泥渗漏、伤椎再骨折、邻椎再骨折和远端椎体再骨折）发生情况；记录并比较两组患者术前和术后1d、1个月、6个月、1年时的疼痛视觉模拟评分（visual analogue scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）。结果：两组患者性别、身高、体重、手术方法、手术时间、出血量、骨水泥注入量、术中透视次数以及术前VAS评分和ODI均无统计学差异（P＞0.05），肌少症组患者年龄较非肌少症组大（80.3±7.9岁 vs 75.7±6.8岁，P＜0.05），而身体质量指数（body mass index，BMI）较非肌少症组小（24.4±2.2kg/m2 vs 26.2±2.4kg/m2，P＜0.05）；两组术后1d、1个月、6个月、1年时的VAS评分及ODI与术前比较均有显著性改善（P＜0.05），肌少症组患者术后1d、1个月、6个月、1年的VAS评分及ODI均显著高于同时间点非肌少症组（P＜0.05）。两组骨水泥渗漏的发生率无统计学差异（9.65% vs 7.34%，P＞0.05），肌少症组患者术后1年内伤椎、邻椎和远端椎体再骨折发生率及总发生率均显著性高于非肌少症组（9.62% vs 2.75%、13.46% vs 5.05%、11.54% vs 4.13%及33.61% vs 11.93%，P＜0.05）。结论：肌少症OTLVCF患者行PVA的临床疗效较非肌少症患者差，1年内椎体再骨折发生率较高。

Effects of sarcopenia on the clinical efficacy of percutaneous vertebral augmentation in the treatment of osteoporotic thoracolumbar vertebral compression fracture

【Abstract】 Objectives: To investigate the effects of sarcopenia on the clinical efficacy of percutaneous vertebral augmentation(PVA) in the treatment of osteoporotic thoracolumbar vertebral compression fracture(OTLVCF). Methods: We retrospectively analyzed the clinical data of 270 patients with OTLVCF who underwent PVA in the Second Affiliated Hospital, Air Force Military Medical University and Honghui Hospital Affiliated to Xi′an Jiaotong University from January 2020 to December 2022. There were 109 males and 161 females; T10 vertebral fracture in 37 cases, T11 fracture in 52 cases, T12 fracture in 68 cases, L1 fracture in 72 cases, and L2 fracture in 41 cases. The patients were divided into sarcopenia group(52 cases) and non-sarcopenia group(218 cases) according to the diagnostic criteria of the European Working Group on Sarcopenia in Older People(EWGSOP), and using the dominant hand grip strength(<28.0kg) and the skeletal muscle index(SMI) at L3 level(<45.4cm2/m2) in male and the dominant hand grip strength(<18.0kg) and SMI at L3 level(<34.4cm2/m2) in female as the diagnostic thresholds. The general data(gender, age, height, weight, body mass fraction, fracture segment, strength of grasp and skeletal muscle index), operative data(surgical method, operative time, intraoperative blood loss, bone cement injection volume and intraoperative fluoroscopy times), and complications(cement leakage, refracture of injured vertebra, refracture of the adjacent vertebra and distal vertebral refracture) after operation of both groups of patients were collected. The visual analogue scale(VAS) and Oswestry disability index(ODI) were collected before operation and on postoperative 1d, at 1 month, 6 months and 1 year postoperatively and compared between the two groups. Results: There was no statistical difference in gender, height, weight, operative method, operative time, blood loss, bone cement injection volume, intraoperative fluoroscopy times, and preoperative VAS score and ODI between the two groups(P>0.05). The patients in the sarcopenia group were older(80.3±7.9 years vs 75.7±6.8 years, P<0.05) and had a smaller BMI(24.4±2.2kg/m2 vs 26.2±2.4kg/m2, P<0.05). The VAS score and ODI of the two groups on 1d and, at 1 month, 6 months and 1 year after operation were significantly improved compared with those before operation(P<0.05). At the same time, the VAS score and ODI in the sarcopenia group were significantly higher than those in the non-sarcopenia group on 1d and, at 1 month, 6 months and 1 year after operation(P<0.05). In terms of complications, there was no significant difference in the incidence of bone cement leakage between the two groups(9.65% vs 7.34%, P<0.05). The incidence of re-fracture of injured vertebrae, adjacent vertebrae and distal vertebrae and the total incidence of re-fracture within 1 year after operation in the sarcopenia group were significantly higher than those in the non-sarcopenia group(9.62% vs 2.75%, 13.46% vs 5.05%, 11.54% vs 4.13% and 33.61% vs 11.93%, P<0.05). Conclusions: The clinical effects of vertebral augmentation(PVA) in patients with sarcopenia are poorer than in non-sarcopenia OTLVCF patients, with higher vertebral re-fracture rates within 1 year after operation.