椎体后凸成形术治疗伴有肋间痛的胸椎压缩性骨折的临床疗效分析

目的:观察椎体后凸成形术治疗胸椎骨质疏松性椎体压缩性骨折并肋间痛患者的疗效,并初步分析其原因。方法:2014年5月至2016年5月,共纳入188例行椎体后凸成形术的胸椎骨质疏松性椎体压缩性骨折患者,按照患者是否有肋间痛分为肋间痛组和无肋间痛组。术后采用疼痛视觉模拟评分(visual analogue scale,VAS)及Oswestry功能障碍指数(Oswestry Disability Index,ODI)评估两组的疗效。比较两组患者的性别、年龄、骨折部位、骨密度、骨折类型,骨折严重程度,分析肋间痛出现的原因。结果:肋间痛组为38例,无肋间痛组为150例,肋间痛的发生率为20.2%。随访时间为6~15个月,平均为8.3个月。两组术后VAS评分及ODI指数均明显下降(P0.05);组间比较,术后3 d及术后1个月差异有统计学意义(P0.05),术后6个月差异无统计学意义(P0.05)。肋间痛组的患者扁平形骨折及严重骨折出现率高,两组骨折类型和骨折严重程度差异有统计学意义(P0.05)。结论:胸椎骨质疏松性压缩性骨折的肋间痛与骨折类型和骨折严重程度有关。椎体后凸成形术对肋间痛有缓解不佳的可能,尤其是术后早期。

Analysis of clinical outcome of kyphoplasty on costal pain related to thoracic osteoporotic compression fractures

Objective: To analyze the clinical outcome of kyphoplasty on costal pain which develops following thoracic osteoporotic compression fractures and evaluate the factors related to costal pain. Methods: From May 2014 to May 2016,a total of 188 patients with thoracic osteoporotic compression fractures undergoing kyphoplasty were reviewed retrospectively. The patients were divided into two groups:the costal pain group included patients who had costal pain after a vertebral fracture and the no costal pain group included patients without costalgia. Visual analogue scale(VAS)and Oswestry Disability Index(ODI)of all patients were measured preoperatively and 3 days,1 month,6 months postoperatively respectively. Gender,age,the fracture level,bone mineral density,vertebral body fracture type,and fracture severity were compared between two groups,and the causes of costal pain were analyzed. Results: Among 188 patients,38 patients (20.2%) complained of costal pain with back pain. The mean follow-up time was 8.3 months (ranged from 6 to 15 months). The VAS and ODI score of two groups decreased after operation,and there was significant difference between pre-operation and post-operation(P<0.05). There was significant difference in VAS score and ODI score between two groups at 3 days and 1 month postoperatively (P<0.05). There was no significant difference in VAS score and ODI score between two groups at 6 months postoperatively (P<0.05). The incidence of applanation-type deformity and severe fracture in the costal group were higher. The fracture type and fracture severity showed significantly difference between two groups(P<0.05). Conclusion: The fracture type and fracture severity had significant relation to costal pain of thoracic osteoporotic compression fractures. The kyphoplasty effect on costal pain may not be effective,especially during early post-operation period.