目的 对比经皮椎体成形术（PVP）及经皮椎体后凸成形术（PKP）治疗骨质疏松合并胸腰椎骨折的疗效,并分析骨质疏松合并胸腰椎骨折术后腰背疼痛的发生率及影响因素。方法 选取2018年1月—2023年1月收治的133例骨质疏松合并胸腰椎骨折患者作为研究对象,按照选择的手术方式分为PKP组（n=70）和PVP组（n=63）。比较两组患者术后康复指标[（首次下床活动时间、住院时间、术后1 d 视觉模拟评分法（VAS）评分、术后3个月Cobb角、术后3个月椎体高度及术后3个月腰背疼痛发生率],采用脊柱功能指数量表（SFI）、日本骨科协会（JOA）评分评估两组患者术前、术后3个月时的腰椎功能。133例患者术后有40例（30.08%）发生疼痛,分析骨质疏松合并胸腰椎骨折术后腰背疼痛的影响因素。结果 PVP组与PKP组患者首次下床活动时间、住院时间、术后1 d的VAS评分、术后3个月Cobb角、术后3个月椎体高度及术后3个月腰背疼痛发生率差异均无统计学意义（P>0.05）。两组患者术前SFI、JOA评分差异无统计学意义（P>0.05）;术后3个月两组患者SFI、JOA评分较术前明显升高,差异有统计学意义（P<0.05）,但组间差异无统计学意义（P>0.05）。非腰背疼痛患者和腰背疼痛患者的性别、年龄、体重指数（BMI）、手术方法、骨折部位、麻醉方式、合并高血压、高血脂、其他基础疾病、合并软组织损伤情况对比,差异无统计学意义（P>0.05）,非腰背疼痛患者和腰背疼痛患者术前的骨密度（BMD）、Cobb角、合并糖尿病、VAS评分和既往骨折史情况对比,差异有统计学意义（P<0.05）;logistic回归分析结果表明,术前BMD、术前Cobb角、合并糖尿病以及既往骨折史为骨质疏松合并胸腰椎骨折患者术后腰背疼痛的独立危险因素（P<0.05）。结论 PVP与PKP治疗骨质疏松合并胸腰椎骨折均能够改善患者腰椎功能,其中术前BMD、术前Cobb角、合并糖尿病以及既往骨折史为骨质疏松合并胸腰椎骨折患者术后腰背疼痛的独立危险因素,因此,对此类患者需及时采取相关措施,预防术后腰背疼痛的发生。

Objective To compare the effects of percutaneous vertebroplasty （PVP） and percutaneous kyphoplasty （PKP） on osteoporosis combined with thoracolumbar fracture, and to analyze the incidence rates and factors affecting postoperative low back pain. Methods A total of 133 patients with osteoporosis combined with thoracolumbar fracture from January 2018 to January 2023 were selected as study subjects. In accordance with the surgical methods, they were divided into PKP group （n=70） and PVP group （n=63）. Postoperative rehabilitation indicators were compared between the two groups, including first off-bed time, hospitalization time, visual analogue scale （VAS） score at 1 d postoperatively, Cobb's angle at 3 months after operation, vertebral height at 3 months after operation and the incidence rate of low back pain at 3 months postoperatively. The spinal function index （SFI） and the Japanese Orthopaedic Association （JOA） were used to assess the lumbar spine function of the two groups of patients before surgery and at 3 months after operation. Among the 133 patients, 40 cases （30.08%） had pain after surgery, and the factors influencing the postoperative low back pain were analyzed. Results The differences in first off-bed time, hospitalization time, VAS score at 1 d postoperatively, Cobb's angle at 3 months after operation, vertebral height at 3 months after operation, and incidence rate of low back pain at 3 months postoperatively between patients in the PVP group and the PKP group were not statistically significant （P>0.05）.The differences in preoperative SFI and JOA scores between the two groups were not statistically significant （P>0.05）; the SFI and JOA scores of the two groups at 3 months postoperatively were significantly higher compared with preoperative scores （P<0.05）, but the differences between the groups were not statistically significant （P>0.05）. There were no significant differences in gender, age, body mass index （BMI）, surgical method, affected body part, anesthesia mode, combined hypertension, hyperlipidemia, other underlying diseases, and combined soft tissue injury between the non-low back pain patients and the low back pain patients （P>0.05）, but there were significant differences in preoperative bone mineral density （BMD）, Cobb's angle, combined diabetes mellitus, VAS scores, and fracture history between the non-low back pain patients and the low back pain patients （P<0.05）. The results of logistic regression showed that preoperative BMD, preoperative Cobb's angle, combined diabetes mellitus, and fracture history were independent risk factors for osteoporosis combined thoracolumbar fracture. Conclusion Both PVP and PKP treatments for osteoporosis combined thoracolumbar fractures can improve patients' lumbar spine function. Preoperative BMD, preoperative Cobb's angle, combined diabetes mellitus, and fracture history are the independent risk factors for postoperative low back pain in patients with osteoporotic thoracolumbar fracture. Therefore, timely measures should be taken to prevent postoperative low back pain in such patients.