经皮椎体成形术后骨水泥强化椎再骨折的保守治疗及疗效分析

Therapeutic effect of conservative treatment of refracture in cemented vertebrae after percutaneous vertebroplasty for osteoporotic vertebral compression fractures

目的探讨保守治疗在经皮椎体成形术（PVP）后骨水泥强化椎再骨折中的应用及疗效。方法 2012年1月~2014年8月采用PVP治疗老年骨质疏松性椎体压缩性骨折（OVCFs）患者324例（381椎体）,其中12例（14椎体）患者再次出现腰背疼痛并经影像学检查证实为骨水泥强化椎再骨折。7例（9椎体）接受保守治疗,方法包括止痛及抗骨质疏松药物干预,支具保护及功能锻炼等。再发骨折时间为首次PVP术后2~20（8±6.7）周。于治疗后7 d、1、3、12个月进行随访,用疼痛视觉模拟评分（VAS）及Oswestry功能障碍指数（ODI）对治疗效果进行评估。结果所有患者获得随访,随访时间13~29（21.3±11.2）个月。治疗后疼痛VAS评分及ODI值均较治疗前有明显下降,差异有统计学意义（P〈0.05）,治疗后7 d、1个月、3个月比较差异有统计学意义（P〈0.05）,3个月与12个月比较差异无统计学意义（P〉0.05）。疼痛VAS评分由治疗前平均（8.3±0.8）分降至1个月平均（3.1±1.2）分及3个月平均（0.8±0.7）分,ODI值由治疗前平均（88.3%±3.2%）降至1个月（56.3%±7.7%）及3个月平均（5.9%±2.8%）。随访期间未发现褥疮、坠积性肺炎、下肢静脉血栓等并发症。结论经皮椎体成形术后骨水泥强化椎再骨折发生率较低,但却是导致PVP术后再发腰背部疼痛的重要原因之一。保守治疗能够有效缓解患者疼痛症状及改善功能,未见明显并发症,中期疗效满意。

Objective To evaluate the therapeutic effects of conservative treatment of refracture in cemented vertebrae after percutaneous vertebroplasty for osteoporotic vertebral compression fractures in elderly patients. Methods Between January,2012 and August, 2014, a total of 324 elderly patients（381 vertebrae） received percutaneous vertebroplasty for osteoporotic vertebral compression fractures. Of these patients, 12 patients（14 vertebrae） complained of recurrence of back pain and were confirmed to have refracture in the cemented vertebrae by imaging examination. Seven of these 12 patients（9 vertebrae）, who were all female with an average refracture time of 8 ± 6.7 weeks（range 2- 20 weeks）, received conservative treatments with analgesics, osteoporosis medication, bracing and physical therapy, and their visual analogue scale（VAS） scores and Oswestry disability index（ODI） at 7 days and 1, 3 and 12 months after the treatment were measured. Results The 7 patients were followed up for 21.3 ± 11.2 months（range 13- 29 months） after conservative treatments. Their VAS score and ODI decreased significantly over time after the treatment（P〈0.05） and showed significant differences between the measurements at 7 days, 1and 3 months（P〈0.05） but not between 3 and 12 months（P〈0.05）. The average VAS score and ODI before treatments were 8.3±0.8 and（88.3 ± 3.2）%, 3.1 ± 1.2 and（56.3 ± 7.7）% at 1 month, and 0.8 ± 0.7 and（5.9 ± 2.8）% at 3 months during the follow- up,respectively. No such complications as phlebothrombosis of the leg, decubitus, or hypostatic pneumonia occurred in these cases. Conclusion Though with a relatively low incidence rate, refracture in the cemented vertebrae is one of the important causes of recurrence of back pain following percutaneous vertebroplasty. Conservative treatment is effective in relieving pain and improving the spine function in such cases without obvious complications.