Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
Department of Pathology, Shanghai Xin Hua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
Pain Physician. 2020 Jan;23(1):E31-E40.
Although percutaneous vertebroplasty (PVP) can effectively relieve the pain for patients with acute osteoporotic vertebral compression fractures (OVCFs), many patients still complain of mild back pain in the early postoperative period.
The aim of this study was to assess the effect of early limited activity (LA) on prognosis after bipedicular small-cement-volume (i.e., PVP) to treat single-segment acute OVCFs.
A prospective study and retrospective observations were performed on 125 patients with a minimum of 1 year of follow-up.
A university hospital orthopedics and pathology departments.
All patients were allocated into an LA group (n = 64) and an unlimited activity group (ULA group, n = 61). Patients in the LA group were suggested to keep time of off-bed activity < 4 hours per day in the first 3 weeks postoperatively. Patients in the ULA group did not limit activity. The demographic, clinical, and radiologic outcomes were assessed, such as pain intensity Numeric Rating Scale (NRS-11) and vertebral height ratio (i.e., fractured vertebral height/adjacent nonfractured vertebral height). Based on outcomes following surgery, all patients were classified as responders (NRS-11 score 1-day postoperation < 50% of preoperative NRS-11 score) or low responders (NRS-11 score 1-day postoperation >= 50% of preoperative NRS-11 score).
The demographic results and complications were similar. In the LA group, NRS-11 scores at 1 and 3 months postoperation respectively were 2.23 ± 0.42 and 1.46 ± 0.40, and corresponding scores respectively were 2.85 ± 0.80 and 1.73 ± 0.77 in the ULA group, and there was a difference in the 2 groups in both time points (P < 0.05). At 12 months postoperation, anterior and middle vertebral height ratio respectively were 78.42% ± 3.52% and 82.37% ± 3.49% in the LA group, which were higher than 76.87% ± 3.68% and 81.10% ± 3.31% in the ULA group (P < 0.05). Thirty-two cases were low responders. Among those, NRS-11 scores at 1 and 3 months postoperation respectively were 2.29 ± 0.45 and 1.53 ± 0.46 in the LA group, which were lower than 3.67 ± 0.80 and 2.56 ± 0.79 in the ULA group (P < 0.05), and at 12 months postoperation, anterior vertebral height ratio was 79.81% ± 3.25% in the LA group and 75.60% ± 3.50% in the ULA group (P < 0.05).
First, some patients lacked the results of bone mineral density during follow-up; second, the limited time in our study was chosen from our previous working experience, which may lack an objective basis; third, NRS-11 is solely used as an indicator of clinical outcomes in our study; finally, our next studies can increase the sample size to improve the clinically difference.
LA in the early period after PVP can help patients achieve more pain relief postoperatively and maintain better vertebral shape, especially for low responders.
Osteoporotic vertebral compression fractures, percutaneous vertebroplasty, Numeric Rating Scale, vertebral height, responders, low responders, limited activity, complications.
经皮椎体成形术（PVP）可有效缓解急性骨质疏松性椎体压缩性骨折（OVCFs）患者的疼痛，但许多患者术后仍有轻度背痛。
本研究旨在评估双极小剂量骨水泥（即 PVP）治疗单节段急性 OVCFs 后早期限制活动（LA）对预后的影响。
对至少随访 1 年的 125 例患者进行前瞻性研究和回顾性观察。
大学医院骨科和病理科。
所有患者分为 LA 组（n=64）和无限制活动组（ULA 组，n=61）。LA 组患者建议术后前 3 周每天下床活动时间<4 小时。ULA 组患者不限制活动。评估了人口统计学、临床和影像学结果，如疼痛强度数字评分量表（NRS-11）和椎体高度比（即骨折椎体高度/相邻非骨折椎体高度）。根据术后结果，所有患者均分为应答者（术后 1 天 NRS-11 评分<术前 NRS-11 评分的 50%）或低应答者（术后 1 天 NRS-11 评分>=术前 NRS-11 评分的 50%）。
LA 组和 ULA 组的人口统计学结果和并发症相似。在 LA 组，术后 1 个月和 3 个月的 NRS-11 评分分别为 2.23±0.42 和 1.46±0.40，相应的评分分别为 2.85±0.80 和 1.73±0.77；在 ULA 组，2 组在这两个时间点均有差异（P<0.05）。术后 12 个月，LA 组的前中椎体高度比分别为 78.42%±3.52%和 82.37%±3.49%，高于 ULA 组的 76.87%±3.68%和 81.10%±3.31%（P<0.05）。32 例为低应答者。其中，LA 组术后 1 天和 3 天的 NRS-11 评分分别为 2.29±0.45 和 1.53±0.46，低于 ULA 组的 3.67±0.80 和 2.56±0.79（P<0.05），术后 12 个月，LA 组的前椎体高度比为 79.81%±3.25%，而 ULA 组为 75.60%±3.50%（P<0.05）。
首先，一些患者在随访期间缺乏骨密度结果；其次，我们研究中的有限时间是根据我们以前的工作经验选择的，可能缺乏客观依据；第三，NRS-11 仅是我们研究中临床结果的一个指标；最后，我们的下一步研究可以增加样本量，以提高临床差异。
PVP 后早期限制活动可帮助患者术后获得更好的疼痛缓解，并保持更好的椎体形状，尤其是对低应答者。
骨质疏松性椎体压缩性骨折、经皮椎体成形术、数字评分量表、椎体高度、应答者、低应答者、限制活动、并发症。
