骨质疏松性椎体压缩骨折经皮椎体后凸成形术后脊柱-骨盆矢状面参数变化及其对邻近椎体继发骨折的影响

Changes in spinopelvic sagittal plane parameters after percutaneous kyphoplasty for osteoporotic vertebral compression fractures and their impact on secondary fractures of adjacent vertebral bodies

中文关键词:  骨质疏松性椎体压缩骨折  脊柱-骨盆矢状面参数  经皮椎体后凸成形术  邻近椎体继发骨折

英文关键词:Osteoporotic vertebral compression fracture  Spinopelvic sagittal parameters  Percutaneous kyphoplasty of vertebral body  Secondary fracture of adjacent vertebrae

中文摘要:

  【摘要】 目的：观察骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fracture，OVCF）患者行经皮椎体后凸成形术（percutaneous kyphoplasty，PKP）后脊柱-骨盆矢状面参数的变化，探讨其对邻近椎体继发骨折（adjacent vertebral compression fracture，AVCF）的影响。方法：选择2018年5月~2022年11月在我院行PKP治疗的201例OVCF患者作为研究对象，PKP术后随访2年，根据随访期间是否发生AVCF将患者分为AVCF组（n=44）和非AVCF组（n=157）。比较两组患者术前和术后1周、1个月及3个月时的脊柱-骨盆矢状面参数、术前和术后3个月时的疼痛视觉模拟量表（visual analogue scale，VAS）评分及Oswestry功能障碍指数（Oswestry disability index，ODI）。采用Pearson相关性检验分析AVCF组和非AVCF组术后3个月各项脊柱-骨盆矢状面参数间的相关性；Logistic回归分析脊柱-骨盆矢状面参数与PKP术后AVCF的相关性；绘制受试者操作特征（receiver operating characteristic，ROC）曲线，分析各项脊柱-骨盆矢状面参数对OVCF患者PKP术后AVCF的预测价值。结果：AVCF组患者术前VAS评分及ODI显著性高于非AVCF组（P<0.05），术后3个月两组患者VAS评分及ODI评分均显著性降低，非AVCF组患者术后VAS评分及ODI均显著性低于AVCF组（P<0.05）。两组患者在不同时点的骨盆倾斜角（pelvic tilt，PT）、矢状面偏移（sagittal vertical axis，SVA）、T1骨盆角（T1 pelvic angle，TPA）、骶骨倾斜角（sacral slope，SS）、腰椎前凸角（lumbar lordosis，LL）及骨盆入射角（pelvic incidence，PI）有显著性差异（P<0.05），非AVCF组手术前后胸椎后凸角（thoracic kyphosis，TK）有显著性差异（P<0.05）；两组间同时间点的胸腰椎后凸角（thoracolumbar kyphosis，TLK）及PT无显著性差异（P>0.05），SVA、PI、TPA、LL、SS及TK有显著性差异（P<0.05）。术后3个月非AVCF组SVA与TPA、TK、TLK、LL、PT相关，TPA与TK、TLK、LL、PI、SS、PT相关，TK与TLK、PT、SS相关，TLK与LL、PI、PT相关，LL与PT、SS相关，PT与SS相关（P<0.05）；AVCF组SVA与TPA相关，TPA与LL、PI、PT、SS相关，PT与PI、SS相关（P<0.05）；TK、SVA、PI、SS、TPA及LL与OVCF患者PKP术后AVCF显著相关（P<0.05）。调整年龄、初始骨折部位、椎体高度恢复率、糖尿病、术前骨折椎体数、骨密度、骨水泥量、骨水泥椎间盘渗漏后，SVA（OR=2.633，95%CI：1.857~3.732）、TPA（OR=2.497，95%CI：1.684~3.702）、TK（OR=3.184，95%CI：2.699~3.755）、LL（OR=0.526，95%CI：0.438~0.631）、PI（OR=0.478，95%CI：0.320~0.715）及SS（OR=0.592，95%CI：0.500~0.701）仍与AVCF显著性相关（P<0.001）；SVA、TPA、TK、LL、PI、SS对OVCF患者PKP术后AVCF均具有一定预测价值[曲线下面积（area under the curve，AUC）>0.750]，其中SVA预测AVCF的AUC值（0.826）高于其他参数，其灵敏度为0.827、特异度为0.757，准确性为0.792。结论：OVCF患者PKP术后AVCF与脊柱-骨盆矢状面平衡情况存在显著相关性，SVA、TPA、TK、LL、SS、PI对PKP术后AVCF的发生均具有一定预测价值；术后3个月SVA、TPA、TK较小及LL、SS、PI较大的OVCF患者PKP术后AVCF发生的概率较小。

英文摘要:

  【Abstract】 Objectives: To observe the changes in spinopelvic sagittal plane parameters after percutaneous kyphoplasty(PKP) in patients with osteoporotic vertebral compression fracture(OVCF), and to explore their impacts on adjacent vertebral compression fracture(AVCF). Methods: 201 patients with OVCF who underwent PKP in our hospital from May 2018 to November 2022 were selected as the study subjects. The patients were followed up for 2 years after PKP surgery, and were divided into AVCF group(n=44) and non AVCF group(n=157) based on whether AVCF occurred during the follow-up period. The spinopelvic sagittal parameters, visual analogue scale(VAS) scores, and Oswestry disability index(ODI) were compared between the two groups of patients before operation and at 1 week, 1 month, and 3 months after surgery. Pearson correlation test was used to analyze the correlations between the spinopelvic sagittal parameters in the AVCF group and non AVCF group at 3 months after surgery; Logistic regression analysis was used to evaluate the correlation between spinopelvic sagittal parameters and AVCF after PKP surgery. The receiver operating charactertics(ROC) curve was drawn to analyze the predictive value of various spinopelvic sagittal parameters for AVCF in patients with OVCF after PKP. Results: The baseline VAS score and ODI of patients in the AVCF group were significantly higher than those in the non AVCF group(P<0.05). 3 months after surgery, the VAS score and ODI of both groups were significantly reduced, and the non AVCF group was significantly lower than the AVCF group(P<0.05). There were significant differences in pelvic tilt(PT), sagittal vertical axis(SVA), T1 pelvic angle(TPA), sacral slope(SS), lumbar lordosis(LL), and pelvic incidence(PI) between the two groups at different time points(P<0.05). The non AVCF group showed a significant difference in thoracic kyphosis(TK) before and after operation(P<0.05). There was no significant difference in thoracolumbar kyphosis(TLK) and PT(P>0.05), while there were significant differences in SVA, PI, TPA, LL, SS, and TK(P<0.05) between the two groups of patients at the same time points. In the non AVCF group, SVA was associated with TPA, TK, TLK, LL, and PT, TPA was associated with TK, TLK, LL, PI, SS, and PT, TK was associated with TLK, PT, and SS, TLK was associated with LL, PI, and PT, LL was associated with PT and SS, and PT was associated with SS at 3 months after surgery(P<0.05). In the AVCF group, SVA was correlated with TPA, TPA was correlated with LL, PI, PT, and SS, and PT was correlated with PI and SS(P<0.05). TK, SVA, PI, SS, TPA and LL were significantly correlated with AVCF after PKP in OVCF patients(P<0.05). After adjustment of age, initial fracture site, vertebral height recovery rate, diabetes, number of fractured vertebrae before operation, bone density, amount of bone cement, and leakage of bone cement into intervertebral disc, SVA(OR=2.633, 95%CI: 1.857-3.732), TPA(OR=2.497, 95%CI: 1.684-3.702), TK(OR=3.184, 95%CI: 2.699-3.755), LL(OR=0.526, 95%CI: 0.438-0.631), PI(OR=0.478, 95%CI: 0.320-0.715), and SS(OR=0.592, 95% CI: 0.500-0.701) were still significantly correlated with AVCF(P<0.001). SVA, TPA, TK, LL, PI, and SS all had certain predictive values for postoperative AVCF in OVCF patients after PKP[area under the curve(AUC)>0.750]. Among them, SVA had a bigger AUC value(0.826) for predicting AVCF than other parameters, with a sensitivity of 0.827, specificity of 0.757, and accuracy of 0.792. Conclusions: There is a significant correlation between AVCF and spinopelvic sagittal balance in OVCF patients after PKP surgery. SVA, TPA, TK, LL, SS, and PI have certain predictive values for the occurrence of AVCF after PKP; Smaller SVA, TPA, TK and larger LL, SS, PI at 3 months after surgery can reduce the probability of AVCF occurrence in OVCF patients after PKP surgery.