经皮椎体增强术治疗骨质疏松性压缩性骨折远处疼痛疗效观察

The clinical efficacy of percutaneous vertebroplasty augmentation for the nonmidline pain of the osteoporotic vertebral compression fracture

目的 观察骨质疏松性压缩性骨折（OVCF）远处疼痛的发生情况,分析经皮椎体增强术对责任椎远处疼痛的临床疗效.方法 90例OVCF患者行经皮椎体成形术（PVP）或椎体后凸成形术（PKP）,观察患者远处疼痛的发生情况,应用视觉模拟（VAS）评分比较术前、术后不同时点患者远处疼痛的程度及其动态变化情况.结果 90例OVCF患者中有44例发生责任椎远处疼痛,其中PVP组37例,占48.1％,PKP组7例,占53.9％,两组疼痛发生率差异无统计学意义（χ2=0.149,P=0.699）,疼痛发生部位PVP组分别位于骶尾部20例、剑突下8例、胸廓外侧6例及肋骨前胸2例,PKP组分别为骶尾部5例、剑突下和胸廓外侧各1例;PVP组患者与PKP患者VAS评分术前、术后即时及末次随访时差异均无统计学意义（t=0.22、0.66、1.13,均P＞0.05）;两组不同时点VAS评分差异均有统计学意义（FPVP=35.65,PPvP＜ 0.01,FPKP=30.44,PPKP＜ 0.01）;两组患者术后72 h时疼痛较术前缓解最为明显（t=33.43,P＜0.01）.结论 责任椎远处疼痛是OVCF中较为常见的临床表现,椎体增强术可有效缓解责任椎远处疼痛.

Objective To assess the effect of percutaneous vertebral augmentation for the relief of pain caused by the osteoporotic vertebral compression fracture（OVCF）.Methods 90 patients with OVCF were performed the percutaneous vertebroplasty（PVP） or kyphoplasty（PKP）.The prevalence of pain,visual analog scales （VAS） of patients before and different time points after operation were observed.Results In 90 cases,44 cases with OVCF were suffered from nonmidline pain,among which 37 cases （48.05%） in the PVP group and 13 cases （53.85%） in the PKP group,the incidence of pain between the two group was not statistically significant（χ2 =0.149,P =0.699）.There were 20 cases with pain in sacrococcygeal area,8 cases below the xiphoid,6 cases in lateral thorax and 2 cases in chest in the PVP group,and 5 cases in sacrococcygeal area,1 case respectively below the xiphoid and in chest in the PKP group; the VAS score between the two groups before surgery （t =0.22,P =0.825）,postoperative instant （t =0.66,P =0.508） and the last follow-up （t =1.13,P =0.263） were not statistically significant; the VAS scores of both groups had significant differences at different time points （FPVP =35.65,PPVP 〈 0.01,FPKP =30.44,PPKP 〈 0.01） ;the pain relief was the most significant 72h after operation（t =33.43,P 〈 0.001）.Conclusion The pain is common clinical manifestations in patients with OVCF,the percutaneous vertebral augmentation can effectively alleviate the nonmidline pain caused by the OVCF.