经皮椎体后凸成形术治疗有远隔部位疼痛的骨质疏松椎体压缩性骨折

Percutaneous kyphoplasty for treatment of distant pain associated with osteoporotic vertebral com- pression fracture

目的分析骨质疏松椎体压缩性骨折（OVCF）患者发生远隔部位疼痛的临床特点，探讨经皮椎体后凸成形术（PKP）治疗伴有远隔部位疼痛OVCF的临床疗效。方法回顾性分析2013年6月至2016年10月行PKP治疗的98例OVCF患者资料，根据疼痛部位不同分为两组：远隔部位疼痛组34例，无远隔部位疼痛组64例，记录远隔部位疼痛组患者出现远隔部位疼痛的位置，并采用疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）评估患者术前、术后疼痛程度及功能障碍情况。结果远隔部位疼痛的发生率为34．7％（34／98）。远隔部位疼痛组患者术前疼痛的部位：腰骶部24例，臀部14例，髂嵴14例，大腿14例，小腿2例。远隔部位疼痛组患者的术前病程[（15．3±12．9）d]较无远隔部位疼痛组[（10．3±7．0）d]长，差异有统计学意义（P〈0．05）。两组患者术后VAS评分、ODI均较术前改善，差异均有统计学意义（P〈0．05）；术前、术后两组患者间VAS评分、ODI的比较差异均无统计学意义（P〉0．05）。结论OVCF患者出现远隔部位疼痛的比例较高，最常见的疼痛部位为腰骶部、臀部、髂嵴及大腿，PKP治疗伴远隔部位疼痛的OVCF具有良好的临床疗效。

Objective To explore the clinical characteristics of the distant pain associated with osteoporotic vertebral compression fracture （OVCF） and the effect of percutaneous kyphoplasty （PKP） on the distant pain. Methods Ninety-eight patients with OVCF were treated with PKP at our department from June 2013 to October 2016. They were divided into 2 groups according the their pain associated with OVCF. There were 34 patients in the distant pain group and 64 ones in the non-distant pain group. The sites of distant pain were recorded. The visual analogue scale （VAS） and Oswestry disability index （ODI） were used to assess the pain and disability severities preoperatively and postoperatively. Results The incidence of distant pain was 34. 7% （34/98）. The distant pain was located at the lumbosaeral area in 24 cases, at the hip in 14 cases, at the iliac crest in 14 cases, at the thigh in 14 cases, and at the calf in 2 cases. The distant pain group had a significantly longer course of preoperative disease （15.3 ＋ 12.9 d） than the non-distant pain group （10.3 ＋ 7.0 d） （ P 〈 0. 05）. The postoperative VAS and ODI were significantly improved after surgery in both groups （ P 〈 0. 05） . There were no significant differences between the 2 groups in preoperative or postoperative VAS or ODI （ P 〉 0. 05） . Conclusions The incidence of distant pain may be high in OVCF patients. The most common sites for distant pain are the lumbosacral area, hip, iliac crest and thigh. PKP can effectively relieve the distant pain associated with OVCF.