经皮椎体后凸成形术治疗骨质疏松性骶骨骨折的镇痛效果：六例研究。
Analgesic effect of sacroplasty in osteoporotic sacral fractures: a study of six cases.
机构信息
Service de Rhumatologie, Groupe Hospitalier du Havre, Hôpital Jacques-Monod, 29 avenue Pierre-Mendès-France, 76290 Montivilliers, France.
出版信息
Joint Bone Spine. 2012 Oct;79(5):500-3. doi: 10.1016/j.jbspin.2011.12.005. Epub 2012 Jan 27.
OBJECTIVES
To evaluate the short-term analgesic effect of sacroplasty in patients with osteoporotic sacral fractures.
METHODS
Single-center retrospective observational study of all patients managed with sacroplasty for osteoporotic sacral fractures between October 2008 and November 2009. For each patient, symptom duration, pain intensity, and analgesic consumption were recorded. Sacroplasty was performed under local analgesia, in the prone position, with computed tomography guidance. The long-axis approach was sued to introduce the needles and polymethylmethacrylate cement along the fracture line(s). Pain was evaluated on a 10-point visual analog scale (VAS) 24 hours before sacroplasty then at the time of weight-bearing resumption 24 hours after the procedure. Hospital stay length before and after the procedures were recorded.
RESULTS
We identified six patients (five women and one man) with a mean age of 83.2 years. All six patients presented with low back pain and four also had buttock pain. The interval from pain onset to diagnosis ranged from 1 month to 1 year. All patients reported that pain onset followed a fall. The mean VAS pain score was 8.2 before sacroplasty and decreased by 7.6 points 24 hours after the procedure (with four patients having a score of 0). Mean hospital stay length were 12 days before and 4 days after sacroplasty. All patients required opioid analgesics before sacroplasty. At discharge, analgesic requirements were a step II analgesic in one patient, acetaminophen in one patient, and no analgesics in four patients. No adverse events were recorded.
DISCUSSION
The findings from our small population are consistent with a recent literature review of 15 case-series studies showing a significant analgesic effect of sacroplasty. The rapid effect of sacroplasty allows prompt ambulation, thus avoiding complications related to immobility.
CONCLUSION
Sacroplasty is effective in relieving pain due to sacral insufficiency fractures.
目的
评估硫酸钙成形术治疗骨质疏松性骶骨骨折的短期镇痛效果。
方法
对 2008 年 10 月至 2009 年 11 月期间因骨质疏松性骶骨骨折接受硫酸钙成形术治疗的所有患者进行单中心回顾性观察性研究。为每位患者记录症状持续时间、疼痛强度和镇痛药使用情况。在局部麻醉下，采用 CT 引导，患者取俯卧位进行硫酸钙成形术。采用长轴入路，沿骨折线插入针并注入聚甲基丙烯酸甲酯骨水泥。在硫酸钙成形术前 24 小时和术后 24 小时开始负重时，使用 10 分制视觉模拟评分（VAS）评估疼痛。记录手术前后的住院时间。
结果
我们共纳入 6 例患者（5 例女性和 1 例男性），平均年龄 83.2 岁。所有患者均表现为腰痛，4 例还伴有臀部疼痛。从疼痛发作到确诊的时间间隔为 1 个月至 1 年。所有患者均报告疼痛发作前有跌倒。硫酸钙成形术前的平均 VAS 疼痛评分为 8.2 分，术后 24 小时疼痛评分降低了 7.6 分（其中 4 例评分为 0）。硫酸钙成形术前的平均住院时间为 12 天，术后为 4 天。所有患者在硫酸钙成形术前均需要使用阿片类镇痛药。出院时，1 例患者需要使用 II 级镇痛药，1 例患者需要使用对乙酰氨基酚，4 例患者无需使用镇痛药。未发生不良事件。
讨论
我们的小样本研究结果与最近的一项文献综述结果一致，该综述纳入了 15 项病例系列研究，结果显示硫酸钙成形术具有显著的镇痛效果。硫酸钙成形术的快速作用可使患者迅速活动，从而避免因长期卧床引起的并发症。
结论
硫酸钙成形术治疗骶骨不稳定性骨折引起的疼痛是有效的。
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