骨质疏松性椎体压缩性骨折PVP术后早期症状复发的处理

Treatment of early symptoms recurrence after percutaneous vertebroplasty in patients with osteo-porotic vertebral fractures

目的 探讨骨质疏松性椎体压缩性骨折椎体成形术（PVP）术后早期症状复发的处理原则.方法 选取住院治疗的23例PVP后2周内症状复发患者,均通过MRI及CT扫描确定患者相同椎体出现再次骨折.18例患者采用再次椎体成形手术治疗,5例患者采用传统中医药治疗.入院及随访1年间收集所有患者标准登记表,包括临床症状、VAS评价疼痛、ODI评价功能恢复.结果 所有患者效果良好且治疗期间无并发症发生.入院及随访结果对比分析发现,VAS评分较术前明显改善（8.3±1.2比2.9±0.7,P〈0.05）,同时ODI评分也较治疗前明显改善（76.4±12.5比26.7±5.6,P〈0.05）.随访发现相关椎体无明显高度丢失,患者椎体功能良好且无并发症出现.结论 对骨质疏松性椎体压缩性骨折PVP术后早期症状复发的治疗,应积极选择个体化治疗方案,详细的治疗前分析对再次手术或保守治疗具有非常重要的作用.

Objective To investigate the treatment of early symptoms recurrence after percutane-ous vertebroplasty in patients with osteoporotic vertebral fractures. Methods Twenty-three patients withrecurrent symptoms within 2 weeks after PVP were selected,MRI and CT scans were performed to deter-mine the recurrence of the same vertebral body fracture. Among the 23 patients,18 patients underwent PVP procedures,and 5 patients received conservative treatments with traditional Chinese medicine. All patients＇standard registration forms were collected during hospitalization and follow-up of 1 year：clinical symptoms,visual analogue scale （VAS）score for pain,Oswestry disability index （ODI）score to evalu-ate functional activity. Results All patients had good results and no complications occurred during the treatment. Analysis of VAS and DOI scores showed significant differences in improvement between pre-treatment and follow-up. The VAS score was significantly improved （8. 3 ± 1. 2 vs. 2. 9 ± 0. 7,P 〈0. 05）,and the ODI score was also significantly improved （76. 4 ± 12. 5 vs. 26. 7 ± 5. 6,P 〈 0. 05）. There was no significant loss of vertebral height at the end of follow-up. There was no complications and all patients with good function after 12 months follow-up. Conclusions Individual treatment techniques are greatly adapted to the management of early symptoms recurrence after percutaneous vertebroplasty. Careful evaluation has an important effect on re-operation or conservative treatments in patients with osteo-porotic vertebral fractures.