骨质疏松性椎体压缩性骨折二次PVP的临床意义

The clinical significance of repeat PVP for treatment of osteoporotic vertebral compression fractures

目的探讨骨质疏松性椎体压缩性骨折患者初次经皮穿刺椎体成形术术后疼痛无明显好转的原因及再次经皮穿刺椎体成形术的临床疗效。方法2007年3月到2008年3月,本院收治了9例骨质疏松性椎体压缩性骨折初次经皮穿刺椎体成形术术后疼痛无明显缓解患者,其中男3例,女6例,平均(72.3±7.4)岁,椎体压缩程度34%～56%,初次PVP骨水泥填充剂量(3.3±1.2)ml,3例有骨水泥非椎管内渗漏。术前视觉模拟疼痛评分(VAS)为(8.12±1.40),所有患者均行常规抗骨质疏松及止痛对症治疗,症状无明显缓解,再次行C臂下经皮穿刺椎体成形术,术后继续抗骨质疏松治疗,定期X光片复查及VAS评分。结果患者平均骨水泥填充剂量(2.1±1.0)ml,术后1个月VAS评分为(2.7±0.9)。所有患者经9～18个月随访,平均(12±3.5)个月,患椎所引起的症状完全缓解的有5例,部分改善的有4例,症状改善率为100%。结论对于初次经皮穿刺椎体成形术术后疼痛无明显好转的骨质疏松性椎体压缩性骨折患者再次PVP手术有明显的临床疗效,部分微骨折未得到良好的骨水泥填充使骨折未得到充分固定是初次PVP失效的可能原因,骨水泥均匀填充可以提高PVP手术的疗效。

Objective To investigate the reason why there is no pain-relief to patient with osteoporotic vertebral compressive fractures who undergoing vertebroplasty and examine if a repeat PVP is effective on pain-relief to these patients. Methods There are 9 patients with unrelieved pain after an initial PVP in this group, the mean age is 72.3±7.4, the compressive rate of the vertebrae range 34%-56 %, and the preoperative visual analog scale score（VAS） score is 8.12±1.40. A repeat vertebroplasty were performed to these 9 patients. The VAS score was use the measure the effective on pain-relief in these patients. Result The mean volume of Polymethylmethacrylate injected in each vertebra was （2.1±1.0）ml in the repeat PVP. During the first month of follow-up after repeat PVP in this series, a mean VAS is 2.7±0.9. After a 9-18 （mean 12±3.5） months follow-up, the Complete and partial pain-relief were reached in 5 and 4 patients. No serious complications related to the proceduresoccurred. Conclusions A repeat PVP is effective at the same vertebral levels in patients without pain-relief who underwent first time PVP. Inadequate or absent filling of cement in the unstable fractured areas of the vertebral body may be the reason for the unrelieved pain after the initial PVP.