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Received:August 14, 2025 Published Online:May 01, 2026
Received:August 14, 2025 Published Online:May 01, 2026
中文摘要: 目的 探讨经皮椎体增强术（PVA）后残余腰背痛（RBP）与腰椎旁肌肉脂肪浸润的相关性，明确肌肉退变在术后疼痛中的作用，为优化骨质疏松性椎体压缩性骨折（OVCF）患者管理提供新依据。方法 回顾性分析2022年9月至2024年9月于南京医科大学第四附属医院接受PVA治疗的557例OVCF患者，根据术后随机2次以上测得视觉模拟评分（VAS）是否≥4分，分为残余痛组（66例）和对照组（491例）。测量L4/5水平腰大肌、多裂-竖脊肌的横断面积及脂肪浸润指数（FII），分析骨水泥注入量、弥散系数、渗漏率等指标，并通过二元logistic回归探讨 RBP 的影响因素。结果 残余痛组多裂肌-竖脊肌FII（35.27%±7.03% vs 29.57%±4.09%，t=6.442，P<0.01）和腰大肌FII（31.34%±4.78% vs 25.80%±3.78%，t=9.043，P<0.01）显著高于对照组；骨水泥注入量两组差异无统计学意义（P>0.05），但对照组骨水泥弥散系数更高、骨水泥渗漏率更低（P<0.01）。多因素分析显示，腰大肌FII（OR =1.304）、多裂肌-竖脊肌FII（OR =1.133）升高及骨水泥渗漏（OR =3.035）是RBP的独立危险因素，而高骨密度（OR =0.645）和骨水泥弥散系数（OR =0.226）为保护因素（P<0.05）。此外，腰大肌及多裂-竖脊肌肌群FII与年龄呈正相关，与骨密度呈负相关（P<0.05）。结论 腰椎旁肌肉脂肪变性（尤其是多裂肌-竖脊肌和腰大肌）与PVA术后RBP显著相关，优化肌肉质量及骨水泥弥散效率可降低RBP风险。
Abstract:Objective To investigate the correlation between residual back pain（RBP）after percutaneous vertebralaugmentation（PVA）and fat infiltration of lumbar paraspinal muscles，and to clarify the role of muscle degeneration in postoperative pain，so as to provide new insights for optimizing the management of osteoporotic vertebral compression fractures（OVCF）. Methods A retrospective analysis was performed on 557 patients with OVCF who underwent PVA from September 2022 to September 2024 in the Fourth Affiliated Hospital，Nanjing Medical University. Patients weredivided into the residual pain group（66 cases）and control group（491 cases）based on whether the Visual Analog Scale（VAS）score measured randomly on two or more occasions postoperatively was ≥ 4 points. The cross - sectional area and fat infiltration index（FII）of the psoas major muscle and multifidus -erector spinae muscle at the L4/5 level were measured，and indicators such as injection volume，diffusion coefficient，and leakage rate bone cement were analyzed. Binary logistic regression was used to explore the influencing factors of RBP. Results The multifidus-erector spinae FII（35.27%±7.03% vs 29.57%±4.09%, t=6.442，P<0.01）and psoas major FII（31.34%±4.78% vs 25.80%±3.78%, t=9.043，P<0.01）in the residual pain group were significantly higher than those in the control group. There was no significant difference in bone cement injection volume between the two groups（P>0.05），but the control group had a higher diffusion coefficient and a lower leakage rate of bone cement（P<0.01）. Multivariate analysis showed that psoasmajor muscle FII（OR =1.304），multifidus - erector spinae muscle FII（OR =1.133），and bone cement leakage（OR =3.035）were independent risk factors for RBP，while high bone mineral density（OR =0.645）and bone cement diffusion coefficient（OR =0.226）were protective factors（P<0.05）. In addition，the lumbar paraspinal muscle FII was positively correlated with age and negatively correlated with bone mineral density（P<0.05）. Conclusion Fatty degeneration of lumbar paraspinal muscles，particularly the multifidus-erector spinae and psoas major muscles，is significantly associated with RBP after PVA. Optimizing muscle quality and bone cement diffusion efficiency can reduce the risk of RBP.
keywords: Osteoporotic vertebral compression fracture Percutaneous vertebral augmentation Residual back pain Lumbar paraspinal muscle fatty degeneration Bone cement diffusion coefficient Bone cement leakage
文章编号： 中图分类号：R683.2 R619+.9 文献标志码：A
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