McKiernan Fergus, Faciszewski Tom, Jensen Ron
Center for Bone Diseases, Marshfield Clinic, 1000 North Oak, Marshfield, Wisconsin 54449, USA.
J Vasc Interv Radiol. 2005 Jul;16(7):973-9. doi: 10.1097/01.RVI.0000163014.71889.16.
Altered vertebral and spinal configuration after osteoporotic vertebral compression fracture (VCF) is believed to contribute to postfracture morbidity. The objective of this study was to determine whether patients in whom partial vertebral height restoration (VHR) was achieved at percutaneous vertebroplasty had greater pain relief or improved quality of life compared with patients in whom no anatomic restoration was achieved.
Consecutive subjects undergoing percutaneous vertebroplasty for painful osteoporotic VCFs completed the Osteoporosis Quality of Life Questionnaire (OQLQ) a validated, disease specific instrument that measures health related quality of life in women with osteoporosis with back pain caused by VCF. At postoperative week 2, month 2, and month 6, all subjects completed the mini-OQLQ, a validated extraction of OQLQ. Pain was rated with a standard visual analogue scale (VAS). Radiographs were manually digitized and evaluated for the presence of dynamic mobility and VHR. The relationship between VHR achieved at percutaneous vertebroplasty and postoperative pain relief and quality of life outcome was examined by multivariate analysis.
Forty-six subjects (32 women) underwent 49 percutaneous vertebroplasty procedures to treat 66 painful VCFs. Mean patient age was 74.3 years+/-10.9. Mean fracture age was 2.5 months+/-2.1. Pain rating fell from 7.7+/-1.8 to 2.8+/-1.8 within 1 day of percutaneous vertebroplasty and remained improved through month 6 (P<.001). All OQLQ domains improved substantially at week 2 (P<.02) and remained improved through month 6 (P<or=.007). Preoperative dynamic mobility ranged -2.9 to 19.9 mm (average, 5.5 mm). Postoperative VHR in mobile VCFs ranged -2.1 to 9.6 mm (average, 2.9 mm). At all postoperative time points up to 6 months, pain and OQLQ domain scores were similar in patients who achieved partial VHR at percutaneous vertebroplasty compared with those in whom no VHR was achieved.
Partial vertebral height restoration achieved at percutaneous vertebroplasty did not result in additional pain relief or improved quality of life beyond cement fixation alone.
骨质疏松性椎体压缩骨折（VCF）后椎体和脊柱形态的改变被认为会导致骨折后发病。本研究的目的是确定与未实现解剖复位的患者相比，经皮椎体成形术实现部分椎体高度恢复（VHR）的患者是否有更大程度的疼痛缓解或生活质量改善。
因疼痛性骨质疏松性VCF接受经皮椎体成形术的连续受试者完成了骨质疏松生活质量问卷（OQLQ），这是一种经过验证的、针对特定疾病的工具，用于测量患有因VCF导致背痛的骨质疏松女性的健康相关生活质量。在术后第2周、第2个月和第6个月，所有受试者完成了小型OQLQ，这是OQLQ的有效提取物。疼痛用标准视觉模拟量表（VAS）进行评分。对X线片进行手动数字化处理，并评估动态活动度和VHR的情况。通过多变量分析研究经皮椎体成形术实现的VHR与术后疼痛缓解及生活质量结果之间的关系。
46名受试者（32名女性）接受了49次经皮椎体成形术，以治疗66处疼痛性VCF。患者平均年龄为74.3岁±10.9岁。骨折平均时间为2.5个月±2.1个月。经皮椎体成形术1天内疼痛评分从7.7±1.8降至2.8±1.8，并在第6个月时仍保持改善（P<0.001）。所有OQLQ领域在第2周时均有显著改善（P<0.02），并在第6个月时仍保持改善（P≤0.007）。术前动态活动度范围为-2.9至19.9毫米（平均5.5毫米）。可活动VCF术后的VHR范围为-2.1至9.6毫米（平均2.9毫米）。在术后长达6个月的所有时间点，经皮椎体成形术实现部分VHR的患者与未实现VHR的患者相比，疼痛和OQLQ领域评分相似。
经皮椎体成形术实现的部分椎体高度恢复，在单纯骨水泥固定之外，并未带来额外的疼痛缓解或生活质量改善。
