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[椎体成形术治疗疼痛性慢性骨质疏松性椎体骨折的疗效。5例报告]

[Effectiveness of vertebroplasty in painful chronic osteoporotic vertebral fractures. A report of 5 patients].

作者信息

Martínez-Ferrer Angels, Blasco Jordi, Guañabens Núria, Pomés Jaume, Peris Pilar

机构信息

Servicio de Reumatología, Hospital Clínic, Universidad de Barcelona, Barcelona, España.

出版信息

Med Clin (Barc). 2013 Feb 2;140(3):115-8. doi: 10.1016/j.medcli.2012.07.027. Epub 2012 Nov 28.

Abstract

BACKGROUND AND OBJECTIVE

Percutaneous vertebroplasty (PVP) has been successfully used in the treatment of pain related to osteoporotic vertebral fractures refractory to medical therapy, especially in the treatment of acute factures. However, the effectiveness of this therapeutic approach in the treatment of painful chronic vertebral fractures is less clear.

PATIENTS AND METHODS

In this report we evaluate the short and long-term effectiveness in pain relief of PVP in a group of 5 patients with pain related to chronic osteoporotic vertebral fractures without bone marrow edema (BME) on magnetic resonance imaging (MRI). All patients were followed during one year, assessing analgesic use, pain evolution (on a 10-point visual analog scale [VAS]), new vertebral fractures and other clinical complications. Seven procedures were performed in the 5 patients.

RESULTS

All patients reported substantial improvement in back pain 2 weeks after the procedure, with a mean decrease of 53% in the VAS. However, one year after PVP most patients (4 out 5) worsened, achieving similar VAS scores to those obtained at baseline. No additional vertebral fractures or other clinical complications were observed.

CONCLUSION

The present cases suggest that the long-term effectiveness of PVP in the treatment of painful chronic vertebral fractures without BME on MRI is scarce.

摘要

背景与目的

经皮椎体成形术(PVP)已成功用于治疗药物治疗无效的骨质疏松性椎体骨折相关疼痛,尤其是急性骨折的治疗。然而,这种治疗方法在治疗疼痛性慢性椎体骨折方面的有效性尚不清楚。

患者与方法

在本报告中,我们评估了5例磁共振成像(MRI)显示无骨髓水肿(BME)的慢性骨质疏松性椎体骨折相关疼痛患者接受PVP治疗后短期和长期的疼痛缓解效果。所有患者随访一年,评估镇痛药物使用情况、疼痛进展(采用10分视觉模拟量表[VAS])、新发椎体骨折及其他临床并发症。5例患者共进行了7次手术。

结果

所有患者术后2周均报告背痛有显著改善;VAS平均降低53%。然而,PVP术后一年,大多数患者(5例中的4例)病情恶化,VAS评分与基线时相似。未观察到额外的椎体骨折或其他临床并发症。

结论

目前的病例表明,PVP治疗MRI显示无BME的疼痛性慢性椎体骨折的长期有效性欠佳。

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