Pain Relief by Percutaneous Vertebroplasty for Osteoporotic Compression Fractures: An Evaluation of Polymethylmethacrylate Injection Volume

經皮脊椎成形術病人骨水泥注入體積和疼痛改善的關係

楊椒喬(Jiao-Chiao Yang) ； 林建邦(Chien-Pang Lin) ； 洪佳雯(Chia-Wen Hong) ； 荘美芳(Mei-Fang Chuang) ； 陳俊賢(Jun-Yeen Chan) ； 蘇彥伯(Yen-Bo Su) ； 黃金山(Jing-Shan Huang) ； 張坤權(Kun-Chuan Chang)

《Formosan Journal of Surgery》 38卷2期 (2005/04) Pp. 49-55

https://doi.org/10.29833/FJS.200504.0001

摘要

經皮脊椎成形術病人骨水泥注入體積和疼痛改善的關係
使用經皮脊椎成形術治療脊椎壓迫性骨折，可以給病人相當程度的疼痛改善，本文探討注入的體積和疼痛程度改善的關係。
我們研究了70位病患，將70位病患分為兩組，當在術中X光呈現椎體後1/3顯影時，則停止注入骨水泥。Group A代表注入體積等於或小於5ml的病人，Group B則代表注入體積大於5ml的病患，A組的病人平均VAS(Visual Analog Pain Score)下降為1.28，改善的程度則為3.28;B組的病人平均VAS(Visual Analog Pain Score)下降為1.09，改善的程度則為3.39，兩組病人的臨床資料在統計上並無差異。
因此，我們認為骨水泥注入的體積和疼痛改善並無絕對的關係，只要術中X光呈現椎體後1/3顯影，達到椎體填充的效果，病人的疼痛即可獲得改善。

並列摘要

Percutaneous vertebroplasty may provide pain relief in the treatment of patients with severe osteoporotic compression fracture. A retrospective study was done to determine the relationship between injection volume and therapeutic benefits. Methods and Results: Polymethylmethacrylate (PMMA) was injected into 79 compression fractures in a total of 70 patients. The amounts of PMMA injected ranged from 2 to 9 milliliters. We divided our patients into two groups according to the volume of PMMA injected. Group A had the volume injected ranging from 2 to 5 milliliters whereas Group B, 6 to 9mL. The injection of bone cement was stopped immediately whenever a backflow opacification was observed in the posterior third of the vertebral body in order to prevent iatrogenic spinal cord compression. In Group A patients, the mean postoperative pain score was decreased to 1.28. The mean decreased pain score was 3.28. In Group B patients, the mean postoperative pain score decreased to 1.09. The mean decreased pain score was 3.39. There was no significant difference between these two groups in the decreased pain score (P=0.52) and postoperative pain status (P=0.14).
Conclusions: The author found no correlation between the injection volume and its therapeutic benefit. Greater amount of PMMA injected will not give a better clinical outcome to patients with osteoporotic compression fracture. The injection of PMMA should be stopped immediately whenever a backflow opacification is observed in the posterior third of the vertebral body in order to prevent epidural leakage. The presence of PMMA epidural leakage may decrease the pain relief benefit after percutaneous vertebroplasty.

並列關鍵字

injection volume ； fracture ； osteoporosis ； vertebroplasty ； polymethylmethacrylate