中国组织工程研究

中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (29): 4635-4640.doi: 10.12307/2023.665

• 脊柱植入物 spinal implant • 上一篇    下一篇

脊柱-骨盆矢状面平衡状态与骨质疏松性椎体压缩性骨折经皮球囊扩张椎体后凸成形效果的关系

董  洲1，2，陶  晖3，刘艺明2，王善松2，李  春2，胡  勇1   

  1. 安徽医科大学第一附属医院，1骨病骨肿瘤外科，3脊柱外科，安徽省合肥市   230022；2合肥市第一人民医院脊柱外科，安徽省合肥市   230010
  • 收稿日期:2022-01-25 接受日期:2022-09-21 出版日期:2023-10-18 发布日期:2022-12-02
  • 通讯作者: 胡勇，博士，主任医师，博士生导师，安徽医科大学第一附属医院骨病骨肿瘤外科，安徽省合肥市 230022
  • 作者简介:董洲，1987年生，安徽省人，汉族，硕士，主治医师，主要从事脊柱外科方面的研究。
  • 基金资助:
    国家自然科学基金(82072492)，项目名称：Sal2b和BMP7修饰的功能化自组装多肽水凝胶材料修复椎间盘退变的应用基础，项目负责人：陶晖

Relationship between spine-pelvic sagittal plane balance and effects of percutaneous balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures

Dong Zhou1, 2, Tao Hui3, Liu Yiming2, Wang Shansong2, Li Chun2, Hu Yong1   

  1. 1Department of Orthopedic Oncology Surgery, 3Department of Spinal Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China; 2Department of Spinal Surgery, Hefei First People's Hospital, Hefei 230010, Anhui Province, China
  • Received:2022-01-25 Accepted:2022-09-21 Online:2023-10-18 Published:2022-12-02
  • Contact: Hu Yong, MD, Chief physician, Doctoral supervisor, Department of Orthopedic Oncology Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
  • About author:Dong Zhou, Master, Attending physician, Department of Orthopedic Oncology Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China; Department of Spinal Surgery, Hefei First People's Hospital, Hefei 230010, Anhui Province, China
  • Supported by:
    The National Natural Science Foundation of China, No. 82072492 (to TH)

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摘要：


文题释义：

球囊扩张椎体后凸成形：经过球囊扩张后再分次注入骨水泥，一方面球囊扩张后留下的空腔周围的松质骨得到压实，人为制造了一个阻止骨水泥渗漏的屏障；另一方面使用推杆分次注入骨水泥较传统的压力泵持续注入显著降低了骨水泥注入时的压力，因此骨水泥的渗漏明显减少。
脊柱-骨盆矢状面平衡：人体躯体平衡主要包括脊柱平衡、骨盆平衡、胸廓平衡和四肢平衡等，临床上常关注的脊柱矢状面平衡参数主要有矢状面偏移、胸椎后凸角、腰椎前凸角。常关注的骨盆矢状面参数主要有两类：①解剖学参数：指骨盆投射角，用来描述骨盆的解剖形态，其存在个体差异，在成年后达到稳定状态，但不受摄片体位和姿势的影响；②姿势相关性参数：包括骨盆倾斜角和骶骨倾斜角，用来描述骨盆的空间方位，受体位和姿势的影响。

背景：骨质疏松性椎体压缩骨折的高患病率给社会经济和医疗带来较大的负担，并且临床治疗中对于最佳治疗的时间以及方法存在重大争议，经皮球囊扩张椎体后凸成形治疗可减少椎体压缩性骨折的并发症，减轻疼痛，加强结构完整性。
目的：探究脊柱-骨盆矢状面平衡状态对骨质疏松性椎体压缩性骨折球囊扩张椎体后凸成形疗效的影响。
方法：回顾性分析2018年8月至2020年1月合肥市第一人民医院收治的74例行球囊扩张椎体后凸成形治疗的病历资料，根据术后随访康复效果分为疗效良好组与疗效欠佳组，每组37例。术前及术后随访比较两组患者的目测类比评分、日本骨科协会评分以及影像学资料等。
结果与结论：①术后疗效欠佳组有3例患者发生骨水泥渗漏，疗效良好组4例患者发生骨水泥渗漏；②在术前与术后1个月时，两组患者的日本骨科协会评分与目测类比评分相比无明显差异(P > 0.05)，在术后12个月时均明显改善，其中疗效良好组明显优于疗效欠佳组(P < 0.05)；③术前两组患者的伤椎高度丢失率、Cobb角、骶骨倾斜角、骨盆倾斜角、骨盆入射角、腰椎前凸角、矢状面偏移以及胸椎后凸角相比较均无明显差异(P > 0.05)；经手术治疗后1个月，两组患者的伤椎高度丢失率、Cobb角以及矢状面偏移评分均发生改善(P < 0.05)；术后12个月疗效欠佳组的伤椎高度丢失率、Cobb角、矢状面偏移、胸椎后凸角、骨盆倾斜角以及骨盆入射角明显大于疗效良好组(P < 0.05)，而腰椎前凸角、骶骨倾斜角明显小于疗效良好组(P < 0.05)；④通过Pearson分析发现日本骨科协会评分与矢状面偏移、胸椎后凸角、骨盆入射角、骨盆倾斜角、骶骨倾斜角呈负相关(P < 0.05)，与腰椎前凸角呈正相关(P < 0.05)；相反，目测类比评分与矢状面偏移、胸椎后凸角、骨盆入射角、骶骨倾斜角呈正相关(P < 0.05)，与腰椎前凸角、骨盆倾斜角呈负相关(P < 0.05)；⑤提示大部分骨质疏松性椎体压缩性骨折患者采用球囊扩张椎体后凸成形治疗后可以起到良好的治疗效果，可以纠正畸形、稳定骨折、减轻疼痛，并且患者的脊柱-骨盆矢状面平衡参数会影响患者的临床疗效。
https://orcid.org/0000-0002-1775-1754 (董洲)

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 椎体压缩性骨折, 骨质疏松, 球囊扩张椎体后凸成形术, 脊柱-骨盆矢状面, 临床疗效

Abstract: BACKGROUND: The high prevalence of osteoporotic vertebral compression fractures leads to a significant socioeconomic and medical burden, and there are controversies about the optimal timing and treatment methods. Percutaneous balloon kyphoplasty can reduce complications, relieve pain, and enhance structural integrity of the vertebral body. 
OBJECTIVE: To investigate the influence of spinal-pelvic sagittal balance on the therapeutic effects of percutaneous balloon kyphoplasty on osteoporotic vertebral compression fractures.
METHODS: The medical records of 74 patients admitted to Hefei First People's Hospital from August 2018 to January 2020 for percutaneous balloon kyphoplasty were retrospectively analyzed, and the included patients were equally divided into the good outcome and poor outcome groups (n=37 per group) according to the postoperative recovery. The visual analog scale scores, Japanese Orthopaedic Association scores, and imaging data of the two groups were compared at baseline and during the postoperative period. 
RESULTS AND CONCLUSION: (1) Cement leakage occurred in three patients in the poor outcome group and four patients in the good outcome group postoperatively, respectively. (2) Visual analog scores in both groups at 1 month postoperatively were similar to baseline (P > 0.05), while the scores were improved significantly at 12 months postoperatively, with the good outcome group significantly better than the poor outcome group (P < 0.05). (3) There was no significant difference in the loss rate of injured vertebral height, Cobb angle, angle of pelvic incidence, pelvic tilt, sacral slope, angle of lumbar anterior convexity, sagittal deviation and thoracic lordosis angle between the both groups (P > 0.05) at baseline, while the loss rate of injured vertebral height, Cobb angle, and sagittal deviation in both groups were significantly improved at 1 month postoperatively (P < 0.05). The rate of height loss of the injured spine, Cobb angle, sagittal deviation, thoracic lordosis angle, pelvic tilt, sacral slope were significantly increased in the poor outcome group compared with the good outcome group (P < 0.05), while the angle of pelvic incidence and angle of lumbar anterior convexity were significantly decreased in the poor outcome group compared with the good outcome group at 12 months postoperatively (P < 0.05). (4) Pearson correlation analysis revealed that Japanese Orthopaedic Association scores were negatively correlated with sagittal deviation, thoracic lordosis angle, pelvic tilt, sacral slope, angle of pelvic incidence (P < 0.05), while were positively correlated with the angle of lumbar anterior convexity (P < 0.05). In addition, the visual analog scale scores were positively correlated with sagittal deviation, thoracic lordosis angle, sacral slope, and angle of pelvic incidence (P < 0.05), while were negatively correlated with the angle of lumbar anterior convexity and pelvic tilt (P < 0.05). (5) These results suggest that percutaneous balloon kyphoplasty can correct deformity, stabilize fracture, and relieve pain, thereby benefiting most of the patients with osteoporotic vertebral compression fractures. Moreover, spine-pelvic sagittal plane balance can affect the clinical efficacy.

Key words: vertebral compression fracture, osteoporosis, percutaneous balloon kyphoplasty, spine-pelvis sagittal plane, clinical efficacy

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