| Background:Osteoporotic vertebral compression fractures are common diseases in spine surgery,which seriously harms the health and living quality of the elderly.Percutaneous kyphoplasty(PKP)has been widely used in the treatment of Osteoporotic thoracic fractures at present.Most patients only show back pain.In clinical work,some patients with osteoporotic thoracic fractures combine with intercostal neuralgia Pain from the fracture site along the intercostal nerve to the anterior chest or abdomen.Very few patients with osteoporotic thoracic fractures were admitted to hospital showed only intercostal neuralgia.The inconvenience of the intense pain caused by osteoporotic thoracic fractures directly reduces the quality of life of patients.At present,the clinical effect and analgesic mechanism of PKP in osteoporotic thoracic fractures with intercostal neuralgia are not yet clear.Objective:To investigation the effect and radiological results of PKP on the treatment of osteoporotic thoracic vertebral fracture combined with intercostal neuralgia.Method:Retrospective analysis of clinical and imaging data of 26 patients with osteoporotic thoracic fracture combined with intercostal neuralgia in our hospital.19 of them were backache with intercostal neuralgia,7 of which were simple intercostal neuralgia.All patients received PKP surgery.The visual analogue scale(VAS),Oswestry disability index(ODI)and VAS improvement rate were used to evaluate the clinical effect.Image-pro plus software was used to measure and calculate anterior vertebral height(AVH),posterior vertebral height(PVH),and segmental kyphosis angle(SKA)by X-ray.Result:We performed PKP for 26 patients(male 6,female 20)with 43 affected vertebral bodies.Average age was 67.5(55-87)years old.After PKP surgery,17 of the 19 patients with posterior back pain and intercostal neuralgia had good relief of intercostal neuralgia,with a remission efficiency of89.5%.All the 7 patients with simple intercostal neuralgia had good remission and the remission efficiency reached 100%.In 26 patients,the effective rate for remission of intercostal neuralgia was 92.3%.The preoperative VAS of intercostal neuralgia was 8.80±0.3,at postoperative was3.15±0.25,1W was 2.55±0.19,1M was 2.04±0.18,1Y was 1.63±0.16 after surgery.The differences were statistically significant(p<0.05),there was no significant difference in pain relief at each time point after surgery.The preoperative ODI was 84.93±2.39%,postoperative was 35.7±3.05%,1W was 31.8± 2.78%,1M was 28.43±2.4%,1Y was 24.21 ±2.42% after surgery.the differences were statistically significant.The heights of anterior vertebral body in postoperative rose from 1.98±0.37 cm to 2.65±0.33 cm(p<0.05).Rectified height was 0.50±0.13 cm.1Y after surgery was 2.59±0.41 cm.The heights of posterior vertebral body in postoperative rose from3.04±0.36 cm to 3.12±0.41 cm(p>0.05).Rectified height was 0.09±0.03 cm.1Y was 3.11±0.39 cm after surgery.The SKA of affected vertebral body decreasing from 24.35±4.65° to 14.67±3.64°(9.67±2.95°)(p<0.05).1Y was14.63±3.56° after surgery.Conclusion:(1)The osteoporotic thoracic vertebral fractures can lead to simple intercostal neuralgia,the incidence of which is 11.3% through our research.The osteoporotic thoracic vertebral fractures can lead to back pain combined with intercostal neuralgia,he incidence of which is 30.6% through our research.(2)PKP can significantly relieve intercostal neuralgia caused by the osteoporotic thoracic vertebral fractures with a remission rate of 92.3%.(3)The intercostal neuralgia of the osteoporotic thoracic vertebral fractures may be the result of multiple factors,because the fracture not only damages the vertebral body,but also affects the adjacent structure of the vertebral body,causing a series of changes that may act as pain generators. |
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