椎体成形术治疗痛性病损椎疼痛缓解不佳原因分析及对策

目的:探讨椎体成形术后疼痛缓解不佳的原因、补救治疗方法和疗效.方法:本组对椎体成形术治疗骨质疏松椎体压缩骨折手术后效果不佳,仅轻微缓解疼痛26例,溶骨性骨肿瘤无效或轻微缓解6例从临床症状和影像学方面对发生原因进行分析,并根据不同情况采取再次椎体成形术补充注射骨水泥,延长卧床时间,佩带护腰或者腰背支具,局部物理治疗,辅助放、化疗等措施.结果:经过2个月～5年随访,平均2年9个月.骨质疏松压缩骨折椎体成形术后效果不佳26例,CR(完全缓解)20例,PR(部分缓解)6例.溶骨性骨肿瘤椎体成形术后效果不佳6例,CR(完全缓解)2例,PR(部分缓解)2例,死亡2例.结论:对骨质疏松压缩骨折和椎体溶骨性骨肿瘤应用椎体成形术治疗术后效果不佳病例,根据发生的不同原因采取不同的补救措施治疗效果满意.

THE CAUSE AND TREATMENT OF POOR OUTCOME IN PAINFUL SPINE INVOLVED INJURY OR PATHOLOGIC CONDITION AFTER PERCUTANEOUS VERTEBROPLASTY

Objective:To analyze the cause of poor outcome after percutaneous vertebroplasty and compensate methods and clinical results.Methods:Twenty six patients performed percutaneous vertebroplasty due to osteoporosis vertebral compression fracture had poor outcomes or little pain relief,and six patients performed percutaneous vertebroplasty due to osteolytic spinal tumor had no or little pain relief.The cause from clinical symptoms to imaging were analyzed.According to different causes,different measures were taken.These measures included performing percutaneous vertebroplasty again to reinjection bone cement,delaying bed-time,wearing thoracolumbar bracing or corsets,local physical therapy,assistting with chemotherapy and radiotherapy.Results;All thirty-two patiens followed up for 2～60 months with an average of 33 months.Among the twenty-six patients who had poor outcome after percutaneous vertebroplasty due to osteoporosis vertebral compression fracture,twenty patients were completely recovered,and six patients were partial recovered.Among the six patients who had poor outcome after percutaneous vertebroplasty due to osteolytic spinal tumor,two patients were completely recovered,two patients were partial recovered,two patients died.Conclusions;According to different causes,different compensate measures were used to treat the patients who had poor outcome after percutaneous vertebroplasty due to osteoporosis vertebral compression fracture or osteolytic spinal tumor.These measures can reach satisfied clinical results.