骨质疏松性椎体压缩性骨折经皮椎体成形术后脊柱-骨盆矢状面参数变化与疗效的关系

关键词：胸椎  骨折，压缩性  骨质疏松  椎体成形术  骨盆测量

Keywords:Thoracic vertebrae  Fractures,compression  Osteoporosis  Vertebroplasty  Pelvimetry

摘要：

      目的 探讨骨质疏松性椎体压缩性骨折（OVCF）经皮椎体成形术（PVP）术后脊柱-骨盆矢状面参数变化与疗效的关系。方法 选取2021年6月—2023年6月采用PVP治疗的胸椎OVCF患者100例作为观察组，另选取同期100名健康体检者作为对照组。记录观察组骨水泥注射量、骨水泥冠状面覆盖率、骨水泥矢状面覆盖率及骨水泥分布类型；手术前后采用视觉模拟量表（VAS）评分及Oswestry功能障碍指数（ODI）评价疼痛程度及功能状态；测量手术前后骨折节段局部Cobb角、骨折椎体前缘高度比。测量观察组手术前后和对照组脊柱-骨盆矢状面参数，包括胸椎后凸角（TK）、腰椎前凸角（LL）、骨盆倾斜角（PT）、骶骨倾斜角（SS）、骨盆入射角（PI）、T₁骨盆角（T₁PA）、T₄PA、L₁PA。结果 观察组术后骨折节段局部Cobb角减小，骨折椎体前缘高度比增加，LL、SS增高，PT、TK、T₁PA、T₄PA、L₁PA降低，VAS评分和ODI显著改善，差异均有统计学意义（P<0.05）。观察组术前TK、PT、LL、SS、T₁PA、T₄PA、L₁PA与对照组相比，差异均有统计学意义（P<0.05）；术后TK、PT、LL、SS、T₁PA、T₄PA、L₁PA与对照组相比，差异均无统计学意义（P>0.05）。PT、SS、LL和TK变化值与术后指标相关性分析结果显示，PT、SS、LL和TK变化值与骨水泥注射量、骨折节段局部Cobb角、VAS评分、ODI、T₁PA、T₄PA、L₁PA呈负相关，与骨水泥冠状面覆盖率、骨水泥矢状面覆盖率、骨折椎体前缘高度比呈正相关。骨水泥分布类型亚组分析显示，均匀型的PT、SS、LL和TK改善情况优于偏侧型和弥散型，差异均有统计学意义（P<0.05）。结论 OVCF患者PVP术后脊柱-骨盆矢状面平衡改善情况影响术后疗效，术后脊柱-骨盆矢状面参数改善越好，疗效越显著。

Abstract:

      Objective To investigate the relationship between changes in spinopelvic sagittal plane parameters and therapeutic efficacy after percutaneous vertebroplasty（PVP） for osteoporotic vertebral compression fractures（OVCF）. Methods From June 2021 to June 2023，100 thoracic OVCF patients treated with PVP were selected as the observation group，and another 100 healthy individuals who underwent physical examinations during the same period as the control group. In the observation group，the injection volume，coronal coverage rate，sagittal coverage rate and distribution type of bone cement were recorded；and pain severity and functional status were evaluated using the visual analog scale（VAS） score and Oswestry disability index（ODI） at pre- and post-operation；and the local Cobb angle and anterior vertebral height ratio of fractured segments were measured at pre- and post-operation. The spinopelvic sagittal plane parameters in the observation group at pre- and post-operation，as well as in the control group were measured，including thoracic kyphosis（TK），lumbar lordosis（LL），pelvic tilt（PT），sacral slope（SS），pelvic incidence angle（PI），T₁ pelvic angle（T₁PA），T₄PA and L₁PA. Results The observation group showed a decrease in local Cobb angle of fractured segments，an increase in the anterior vertebral body height ratio of fractured segments，an increase in LL and SS，a decrease in PT，TK，T₁PA，T₄PA and L₁PA，and significant improvement in VAS score and ODI at post-operation，all with a statistical significance（P<0.05）. The differences in TK，PT，LL，SS，T₁PA，T₄PA and L₁PA between the observation group at pre-operation and the control group were statistically significant（P<0.05）；there was no statistically significant difference in TK，PT，LL，SS，T₁PA，T₄PA and L₁PA between the observation group at post-operation and the control group（P>0.05）. The correlation analysis between changes of PT，SS，LL and TK and postoperative indicators showed that changes of PT，SS，LL and TK were negatively correlated with bone cement injection volume，local Cobb angle of fracture segments，VAS score，ODI，T₁PA，T₄PA and L₁PA，and positively correlated with coronary coverage rate and sagittal coverage rate of bone cement，and anterior vertebral height ratio of fractured segments. Subgroup analysis of bone cement distribution types showed that the improvement of PT，SS，LL，and TK in the uniform type was better than that in the lateral and diffuse types，all with a statistical significance（P<0.05）. Conclusions The improvement of spinopelvic sagittal balance in OVCF patients after PVP affects the postoperative efficacy. The better the improvement of spinopelvic sagittal parameters，the more significant the therapeutic effect.