胸腰段脊柱压缩骨折远隔部位疼痛与胸腰段压缩骨折的关系研究

目的:研究胸腰段脊柱压缩骨折远隔部位疼痛与胸腰段压缩骨折的关系。方法:选取胸腰椎脊柱压缩骨折病人65例作为研究对象，按照胸腰椎脊柱压缩骨折是否伴发远隔部位疼痛，将病人分为观察组13例和对照组52例。取手术切口邻近多裂肌组织作为标本，冰冻病理切片，进行免疫组织化学染色，判断神经递质与隔部位疼痛的相关性；通过椎体前缘与后缘高度比例计算伤椎压缩度；比较2组手术前后VAS评分、ODI指数以及JOA评分。结果:2组病人手术前后伤椎压缩度差异均无统计学意义（P>0.05），2组术后伤椎压缩度均较术前明显改善（P<0.01）。术前，2组病人VAS和JOA评分差异均无统计学意义（P>0.05），观察组ODI指数高于对照组（P<0.05）；术后，观察组VAS评分和ODI指数均明显高于对照组，JOA评分明显低于对照组（P<0.01）。免疫组织化学染色显示，观察组SP、CGRP、IL-6抗体均呈阳性，血管内皮细胞胞浆、血管邻近组织中可见棕黄色颗粒；对照组和空白对照组SP、CGRP、IL-6抗体均呈阴性。结论:SP、CGRP、IL-6神经递质介导的炎性反应对脊神经后支造成一定刺激，可能是胸腰段脊柱压缩骨折病人远隔部位疼痛的重要原因。

Study on the relationship between the distant pain and thoracolumbar compression fractures

Objective:To study the relationship between the distant pain and thoracolumbar compression fractures.Methods:Sixty-five patients with thoracolumbar compression fractures were divided into observation group(13 cases) and control group(52 cases) according to the distant pain.The multifidus muscle tissue near the operation incision were detected using immunohistochemistry to identified the correlation of neurotransmitter with septal part pain.The compression degree of injury vertebra was calculated by the ratio of the height of vertebral anterior to posterior margin.The VAS score,ODI index and JOA between two groups before and after operation were compared.Results:There was no statistical significance in the compression degree of injury vertebral between two groups before and after operation(P>0.05),the compression degree of injured vertebra in two groups after operation was significantly improved compared with before operation(P<0.01).Before operation,the differences of the VAS and JOA score scores between two groups were not statistically significant(P>0.05),and the ODI index in observation group was significantly higher than that in control group(P<0.05).After operation,the score of VAS and ODI index in observation group was significantly higher than that in control group(P<0.01),and the score of JOA in observation group was significantly lower than that in control group(P<0.01).The results of immunohistochemistry showed that the antibodies of SP,CGRP and IL-6 were positive,the brown granules in cytoplasm of vascular endothelial cell and tissue adjacent to blood vessels were found in observation group.The antibodies of SP,CGRP and IL-6 in control group were negative.Conclusions:The SP,CGRP and IL-6 neurotransmitter-mediated inflammatory response may be a stimulus to the posterior ramus of spinal nerve,which may be the key cause of pain in distal part of thoracolumbar compression fractures.