经皮椎体成形术中骨水泥相对于骨折椎体的位置对患者术后疼痛的影响

Influence of Bone Cement Placement to Fracture Vertebral Places During Percutaneous Vertebroplasty on Patients with Postoperative Pain

目的探讨骨质疏松性椎体压缩骨折行经皮椎体成形术(PVP)中骨水泥相对于骨折椎体的位置对患者术后疼痛的影响。方法北京军区总医院2005年1月—2010年3月采用PVP治疗骨质疏松性椎体压缩骨折192例,患者均为首次且单个椎体的新鲜压缩骨折。收集患者临床资料及术后1周、1个月、6个月的影像学和疼痛评分资料。根据骨水泥在椎体内的位置分为3组,第1组(31例):骨水泥位于椎体内,未接触终板;第2组(121例):骨水泥扩散,与终板接触;第3组(40例):骨水泥扩散并经终板渗漏到椎间隙。比较3组在术后各随访时点疼痛评分及疼痛缓解程度。结果 3组性别、年龄、骨密度、骨水泥注入量差异无统计学意义(P>0.05)。3组术前及术后各随访时点休息、活动时疼痛程度评分和疼痛缓解程度差异无统计学意义(P>0.05)。结论术中骨水泥相对于骨折椎体的位置对PVP后患者疼痛无显著影响。

Objective To explore influence of bone cement placement to fracture vertebral places in treatment of osteoporotic vertebral compression fractures by pereutaneous vertebroplasty （PVP） on patients＇ postoperative pain. Meth- ods A total of 192 patients with osteoporotic vertebral compression fractures during January 2005 and March 2010 in our hospital underwent PVP. All patients were first time and single vertebral fresh compression fractures. The clinical data and after operations at 1 week, 1 month and 6 months imaging data and pain scores by pain-intensity numerical rating scale were collected. The patients were divided into three groups based on bone cement places in vertebral body： bone ce- ment existed in vertebral body without extension to the endplate （group 1, n = 31 ） ; bone cement diffused to the endplate but no leakage into the disk space （group 2, n = 121 ） ; bone cement diffused to the endplate and percolated into the disk space （group 3, n = 40）. The pain scores and pain relief degrees at correlative times of the three groups were compared. Results The differences of gender, age, bone density and injection volume of bone cement in three groups were not sta- tistically significant （P 〉 0.05）. The differences in pain scores and average pain relief degrees at rest and action at all time points before and after operation with follow-up were not statistically significant （P 〉 0.05）. Conclusion The bone cement placement to fracture vertebral places during operation may be no significant influence on postoperative pain by PVP.