骨质疏松性椎体压缩骨折患者术后腰背疼痛原因分析

Cause analysis of back pain after vertebroplasty or kyphoplasty

目的 分析骨质疏松性椎体压缩骨折经皮椎体成形术（PVP）或经皮球囊扩张后凸成形术（PKP）术后腰背疼痛原因.方法 回顾性分析2004年1月至2014年12月北京积水潭医院脊柱外科因骨质疏松性椎体压缩骨折行PVP或PKP 1 863例,收集分析患者术前、术中以及术后的相关信息,患者术后随访3个月以上,以患者随访时腰背痛视觉模拟评分（VAS） ＞5分或自觉疼痛缓解不足50％视为疼痛不缓解,将术后腰背痛是否缓解分别与术前术中以及术后的各项因素做相关性分析.结果 术后疼痛不缓解仅与术后并发症相关（p＜0.001）,而与其他所观察因素均无相关性.在1 863例患者中,283例（15.2％）疼痛不缓解.其中其他椎体再次骨折87例（相邻椎体67例、不相邻椎体20例）,手术椎体不愈合3例,术后感染1例,误诊6例,无明确原因186例.结论 椎体成形术后疼痛原因众多,目前尚不完全明确.如积极对症及抗骨质疏松情况下症状不缓解或加重,应关注再骨折、不愈合、感染、病理性骨折等其他情况.

Objective To analyze the causes of back pain after vertebroplasty or kyphoplasty.Methods 1 863 patients with back pain who underwent vertebroplasty or kyphoplasty from Jan.2004 to Dec.2014 in Department of Spine Surgery,Beijing Jishuitan Hospital,were followed up for least 3 months after surgery with their back pain evaluated by VAS scores.Related information including preoperative,operative and postoperative factors was gathered.The VAS at last follow-up over 5 or the symptom relief less than 50% was considered as non-relieved,the correlations between the symptom relief and potential influencing factors were analyzed by the Spearman correlation.Results Symptom relief was only correlated with postoperative complications （P 〈 0.001）.The back pain in 283 cases （15.2%） had not been relieved.Among them,87 cases got fractures in other vertebrae （adjacent vertebrae in 67 cases,nonadjacent vertebrae in 20 cases）;3 cases got nonunion in the operated vertebrae;1 case got postoperative infection;6 cases got misdiagnosis and the other 186 cases had no known causes for the unrelieved pain.Conclusions Postoperative back pain after vertebroplasty or kyphoplasty may have variable causes,and some of which have not been entirely understood.If the symptoms are not alleviated or even aggravate after active symptomatic treatment and anti-osteoporotic therapy,underlying causes such as re-fracture,nonunion,infection,pathologic fracture should be sought out.