经皮椎体增强术治疗骨质疏松性压缩性骨折远处疼痛的价值

Response of pain beyond the osteoporotic vertebral compression fracture to percutaneous vertebral augmentation

目的分析骨质疏松性压缩性骨折椎（责任椎）远处疼痛的发生率，评估经皮椎体增强术治疗责任椎远处疼痛的价值。方法回顾性研究2006年12月至2008年8月采用椎体增强术（经皮椎体成形术或经皮后凸成形术）治疗的104例骨质疏松性压缩性骨折患者术前出现责任椎远处疼痛的部位和程度，手术前、后疼痛程度和活动能力评分分别采用视觉模拟法（VAS）和日常生活能力法（ADL）评分。结果104例患者术前共48例（46．2％）发生责任椎远处疼痛，主要分布在骶尾部和臀部（26．0％），其次在腹部和剑突下（10．6％），再次在胸廓外侧、肋骨和胸前（9．6％）。患者总体VAS评分从术前（8．9±0．8）分下降至术后（2．9±1．4）分，差异有统计学意义（t=37．410，P=0．000）；ADL评分从术前（4．1±0．6）分下降至术后（2．0±0．7）分，差异有统计学意义（t=25．331，P=0．000）。其中发生责任椎远处疼痛患者VAS评分从术前（8．8±0．9）分下降至术后（2．8±1．5）分，差异有统计学意义（t=23．722，P=0．000）；ADL评分从术前（4．2±0．7）分下降至术后（2．0±0．7）分，差异有统计学意义（t=15．373，P=0．000）。结论责任椎远处疼痛是骨质疏松性压缩性骨折常见的临床表现，是椎体源性的牵涉痛，主要发生在骶尾部和臀部。椎体增强术可有效缓解南椎体骨折导致的责任椎远处疼痛。

Objective To determine the prevalence of pain beyond the osteoporotic vertebral compression fracture （OVCF） in patients undergoing pereutaneous vertebral augmentation and the response of pain to the treatment. Methods A retrospective study of 104 patients undergoing percutaneous vertebral augmentation （percutaneous vertebroplasty and percutaneous kyphoplasty） was performed to examine the locations and severities of pain beyond the OVCF before and after operation. The Visual Analog Sscale （VAS, 10-point scale） and Activities of Daily Living （ADL, 5-point scale） were used. Results Of the 104 patients, 48 （46. 2% ） suffered pain beyond the OVCF. The pain was firstly located in the saerocoecygeal region and buttocks （26.0%）, secondly in the abdomen and sub-xiphoid process （ 10. 6% ） and thirdly in the flank, ribs and chest （9.6%） . For all the cases, the mean VAS score decreased from 8.9 ＋-0.8 before vertebral augmentation to 2.9 ± 1.4 after augmentation （ t = 37. 410, P = 0. 000）, and the mean ADL score decreased from 4. 1 ±0.6 before operation to 2.0 ±0. 7 after operation （ t =25. 331, P =0. 000） . For the patients suffering pain beyond the OVCF, the mean VAS score decreased from 8.8 ±0. 9 before vertebral augmentation to 2.8 ± 1.5 after augmentation （ t = 23. 722, P = 0. 000）, and the mean ADL score decreased from 4.2 ± 0. 7 before operation to 2.0 ±0.7 after operation （ t = 15. 373, P = 0. 000）. The decreases in VAS and ADL scores were not affected by the pain. Conclusion The percutaneous vertebral augmentation can effectively relieve the pain beyond the OVCF.