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目的探讨骨质疏松性椎体压缩性骨折患者初次经皮穿刺椎体成形术术后疼痛无明显好转的原因及再次经皮穿刺椎体成形术的临床疗效。方法2007年3月到2008年3月,本院收治了9例骨质疏松性椎体压缩性骨折初次经皮穿刺椎体成形术术后疼痛无明显缓解患者,其中男3例,女6例,平均(72.3±7.4)岁,椎体压缩程度34%～56%,初次PVP骨水泥填充剂量(3.3±1.2)ml,3例有骨水泥非椎管内渗漏。术前视觉模拟疼痛评分(VAS)为(8.12±1.40),所有患者均行常规抗骨质疏松及止痛对症治疗,症状无明显缓解,再次行C臂下经皮穿刺椎体成形术,术后继续抗骨质疏松治疗,定期X光片复查及VAS评分。结果患者平均骨水泥填充剂量(2.1±1.0)ml,术后1个月VAS评分为(2.7±0.9)。所有患者经9～18个月随访,平均(12±3.5)个月,患椎所引起的症状完全缓解的有5例,部分改善的有4例,症状改善率为100%。结论对于初次经皮穿刺椎体成形术术后疼痛无明显好转的骨质疏松性椎体压缩性骨折患者再次PVP手术有明显的临床疗效,部分微骨折未得到良好的骨水泥填充使骨折未得到充分固定是初次PVP失效的可能原因,骨水泥均匀填充可以提高PVP手术的疗效。
Objective To investigate the causes of postoperative pain in primary percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures and the clinical effect of percutaneous vertebroplasty. Methods From March 2007 to March 2008, 9 cases of osteoporotic vertebral compression fractures were treated with primary percutaneous vertebroplasty in our hospital without pain relief. There were 3 males and 6 females , Mean (72.3 ± 7.4) years old, degree of vertebral body compression 34% ~ 56%, initial PVP bone cement filling dose (3.3 ± 1.2) ml, 3 cases of non-spinal canal cement leakage. The preoperative visual analogue pain score (VAS) was (8.12 ± 1.40). All patients underwent conventional anti-osteoporosis and analgesic symptomatic treatment. The symptoms were not relieved. Percutaneous vertebroplasty under C-arm was performed again. Continue anti-osteoporosis treatment, regular X-ray examination and VAS score. Results The average amount of bone cement filler (2.1 ± 1.0) ml and the VAS score at 1 month after operation were (2.7 ± 0.9). All patients were followed up for 9 to 18 months, with an average of (12 ± 3.5) months. Five patients had complete remission of symptomatic symptoms caused by vertebrae, four improved partially, and the rate of symptom improvement was 100%. Conclusions For patients with primary osteoporotic vertebral compression fractures who have no significant improvement in the pain after primary percutaneous vertebroplasty, there is a significant clinical effect of PVP surgery. Some of the fractures are not well filled with bone cement and the fractures are not obtained Adequate fixation is a possible cause of initial PVP failure. The uniform filling of the cement can improve the curative effect of PVP surgery.