椎体后凸成形术后疼痛的原因分析

Causes of the Pain after Kyphoplasty for Vertebral Compressive Fractures

目的探讨椎体后凸成形术治疗椎体压缩骨折术后疼痛的原因。方法 8例骨质疏松性椎体压缩骨折行椎体后凸成形术后仍然疼痛原因:2例出现骨水泥渗漏;3例术中出现椎弓根骨折;2例随访中出现邻近节段骨折;1例术后检查发现转移性病理骨折。骨水泥渗漏和椎弓根骨折患者给予镇痛和卧床休息及继续抗骨质疏松治疗,2例邻近节段骨折再次行椎体后凸成形术,1例转移性病理骨折进行放化疗。结果 8例随访3～12个月,平均7个月,7例骨质疏松性骨折治疗前VAS(3.5±1.5)分,治疗后VAS(1.2±0.5)分;1例病理性骨折治疗前VAS评分为4分,随访时VAS为1.3分。结论椎体后凸成形术治疗骨质疏松性椎体压缩骨折术后疼痛原因包括骨水泥渗漏、椎弓根骨折、邻近节段骨折等,应对术后疼痛进行个体化处理。

Objective To evaluate the causes of post-kyphoplasty pain in patients with vertebral compressive fractures. Methods Totally 8 patients with osteoporotic compressive fractures, who had pain after kyphoplasty, were enrolled in this study. Among the patients, two had bone cement leakage, three showed pedicle fractures, two were diagnosed with adjacent segment fractures, and one were confirmed with metastatic pathologic fracture by postoperative examinations. The patients who had cement leakage or pedicle fractures received analgesia, bed rest and anfi-osteoporosis treatments, while those who developed adjacent segment fractures or metastatic pathologic fracture received chemotherapy. Results The eight patients were followed up for 3 to 12 months with a mean of 7 months, during which the VAS of the 7 cases of osteoporotic compressive fractures decreased from 3. 5 ±1. 5 preoperatively to 1.2 ± 0.5, and that in the patient with pathological compressive fracture decreased from 4 to 1.3. Conclusions Pain after kyphoplasty for osteoporotic compressive fractures can be caused by bone cement leakage, pedicle fractures, or adjacent segment fractures. Individualized therapy shall be carried out for post-kyphoplasty pain.