在因老年痴呆而减少治疗相关安慰剂效应的患者中应用椎体强化术的效果分析

Analysis of effect of percutaneous vertebral augmentation in patients with a decreased expectation-related placebo effect due to dementia

目的探讨椎体强化术(PVA)治疗老年痴呆症患者骨质疏松性椎体压缩骨折(OVCF)的效果。方法 11例合并OVCF的老年痴呆症患者分别行PVA(n=6)及非手术治疗(n=5),分析患者治疗前、治疗后3 d、1周、1个月、6个月、1年疼痛、局部活动度、止痛药服用次数、卧床并发症及自主离床超过30 min(AMT 30)的时间点。结果手术组疼痛方面,术后3 d时75%患者疼痛减轻,6个月后为100%;活动度上,术后7 d时50%患者得到改善,6个月后为100%;术后3 d时50%患者停服止痛药,术后7 d后为100%;平均AMT 30时间为3.67 d;无并发症发生。非手术组治疗1个月内,均需服止痛药,活动度改善不明显;平均AMT 30时间为32.20 d;80%出现卧床并发症。结论 PVA在老年痴呆症患者这一特殊人群中的疗效显著,因他们缺少安慰剂效应,这更说明PVA的效果确切存在,而非安慰剂效应。

Objective To analyze the effect of percutaneous vertebral augmentation （PVA） on osteoporotic vertebral compression fractures （OVCF） in patients with a decreased expectation-related placebo effect due to dementia. Methods Eleven elderly cases who were diagnosed as OVCF associated w/th dementia were retrospectively analyzed. Patients were divided into operative group （n =6） who underwent percutaneous vertebral augmentation and conservative group （n =5） who performed conservative therapy. The patients＇s pain during rest and activity, disabled status of thoracolumbar mobility, and the quantity of using pain-medication were analyzed before and 3 days , 1 week, 1 month, 6 months, and 1 year after operation. Complication related with bed rest and time of patients ambulating for more than 30 minutes were recorded in both groups after treatment. Results In operative group, postoperative pain relief is significant in 75% patients at 3 days and in 100% patients at 6 months. Improved mobility was reported in 50% of patients at 7 days and 100% at 6 months after operation. 50% patient didn＇t need using pain medicine 3 days after operation, since 7 days after operation, all of patients stopped using pain medicine. Time of patients ambulating for more than 30 minutes （AMT 30） was average 3.67 days. There was no complication related with bed rest in operative group. In conservative group, all of patients still need to take anesthetic drug, and their activity had no significant improvement after 1 month. AMT 30 was average 32.30 days. 80% of patients had complications related with bed rest. Conclusion There is significant effect of percutaneous vertebral augmentation on osteoporotic vertebral compression fractures associated with dementia. Due to the decreased expectation-related placebo effect in these special patients, it indicates that the effect of pain relief secondary to percutaneous vertebral augmentation might not be related with placebo effect.