| Objective:To explore the causes of postoperative residual pain after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures,and to analyze and summarize the related factors and countermeasuring strategies.Methods:This study was based on a retrospective analysis of 298 patients who underwent percutaneous vertebroplasty for osteoporotic vertebral compression fractures at the Department of Spinal Surgery of our hospital between January 2017 and July 2018.According to whether the decrease of VAS(Visual Analogue Scale)score was more than 5points and whether the degree of pain relief was less than 70%,the patients were divided into 2 groups: postoperative residual pain group: 42 cases;postoperative no residual pain group: 256 cases.X-ray,CT,MRI,whole body bone imaging and bone mineral density examination were performed before operation.The patients were divided into four subtypes A,B1,B2 and C according to the pain condition.The VAS score was also performed.The postoperative X-ray examination and three-dimensional reconstruction CT of vertebral body were performed.The VAS score was recorded on the first day after operation.Postoperative follow-up observation,and regular review,record and compare the type of pain,bone mineral density,QCT,the number of fractured vertebral body,the area of fractured vertebral segment,fascial injury,the shape of bone cement in the vertebral body,the distribution of bone cement in the vertebral body,whether the bone cement covers the fracture line,the type of bone cement leakage,the degree of recovery of the height of injured vertebra,the degree of correction of segmental kyphosis and the balance of sagittal plane of spine.Through univariate and multivariate statistical analysis,the factors associated with postoperative residual pain were screened,and two independent sample t-tests and chi-square tests were performed.Results:In the group without residual pain after operation,299 vertebral bodies were covered with bone cement,accounting for 83.52%,59 vertebral bodies were not covered with fracture line,accounting for 16.48%;in the group with residual pain after operation,22 vertebral bodies were covered with bone cement,accounting for 48.83%,26 vertebral bodies were not covered with fracture line,accounting for 54.17%;whether the bone cement was covered with fracture line(? 2 = 36.315,P = 0.000 < 0.05)had statistical difference in whether residual pain occurred after vertebroplasty,and bone cement was not covered with fracture line,postoperative residual pain was more likely to occur;in the group without residual pain after operation,247 vertebral bodies were bilaterally distributed,accounting for68.99%;81 vertebral bodies were unilaterally distributed,accounting for 22.63%;30vertebral bodies were centrally distributed,accounting for 8.38%;in the group with residual pain after operation,26 vertebral bodies were bilaterally distributed,accounting for 54.17%;(P = 0.001 < 0.05)for residual pain after vertebroplasty,unilateral distribution of bone cement was more likely to have postoperative residual pain;postoperative residual pain group of 42 patients had 12 cases of pain type A(28.57%),6 cases of pain type B1(14.29%),6 cases of pain type B2(14.29%),18 cases of pain type C(42.86%);postoperative no residual pain group of 256 patients had 132 cases of pain type A(51.56%),80 cases of pain type B1(31.25%),19 cases of pain type B2(7.42%),25 cases of pain type C(9.77%),pain type(?2 = 29.298,P= 0.000 < 0.05)for residual pain after vertebroplasty was more likely to have postoperative residual pain.In the postoperative residual pain group,20 patients(47.62%)had fascia injury and 22 patients(52.38%)had no fascia injury;in the postoperative residual pain group,100 patients(39.06%)had fascia injury and 156 patients(87.6%)had no fascia injury,and the fascia injury(? 2 = 1.098,P = 0.295 > 0.05)had statistically significant difference in whether there was residual pain after vertebroplasty;in the postoperative residual pain group,250 vertebral bodies(70.03%)had cement mass distribution;107 vertebral bodies(29.97%)had cement cloud distribution;in the postoperative residual pain group,39 vertebral bodies(81.25%)had cement mass distribution;9 vertebral bodies(18.75%)had cloud distribution,and the cement shape(?2 =2.607,P = 0.106 > 0.05)had statistical difference in whether there was residual pain after vertebroplasty;in 190 vertebral bodies(53.1%)had no bone leakage(53.1%).8(2.24%)vertebral bodies with zone 2 leakage,9(2.52%)vertebral bodies with zone 3 leakage,13(3.64%)vertebral bodies with zone 4 leakage,75(21.01%)vertebral bodies with zone 5leakage,18(5.04%)vertebral bodies with zone 1 combined with zone 5 leakage,4(1.12%)vertebral bodies with zone 2 combined with zone 5 leakage,6(1.68%)vertebral bodies with zone 3 combined with zone 5 leakage,9(2.52%)vertebral bodies with zone 4 combined with zone 5 leakage;29(60.42%)vertebral bodies without cement leakage,1(2.08%)vertebral body with zone 1 leakage,1(2.08%)vertebral bodies with zone 2 leakage,2(4.08%)vertebral bodies with zone 3 leakage,2(4.17%)vertebral bodies with zone 4(4.17%)vertebral bodies with zone 5 combined with zone 5 leakage,7(14.58%)vertebral bodies with zone 1 combined with zone 5 leakage,There were 2 vertebral bodies(4.17%)with leakage in zone 3 combined with zone 5,1 vertebral body(2.08%)with leakage in zone4 combined with zone 5,and leakage type I(?2 = 6.166,P = 0.654 > 0.05)with statistically significant difference in whether residual pain occurred after vertebroplasty;in the group with no postoperative residual pain,there were 190 vertebral bodies(53.07%)without bone cement leakage,32 vertebral bodies(8.94%)with type A leakage,13 vertebral bodies(3.63%)with type B leakage,9 vertebral bodies(2.51%)with type C leakage,75 vertebral bodies(20.95%)with type D leakage,2 vertebral bodies(0.59%)with type E leakage,22 vertebral bodies(6.15%)with type A combined with type D leakage,and 9 vertebral bodies(2.51%)with type B combined with type D leakage,6 vertebral bodies(1.68%)with type C leakage,28 vertebral bodies(58.33%)with no postoperative residual bone cement leakage,and 2 vertebral bodies(4.17%)with type A leakage,There was a statistically significant difference in the presence of residual pain after vertebroplasty between 2 vertebral bodies with type B leakage(4.17%),2 vertebral bodies with type C leakage(4.17%),7 vertebral bodies with type D leakage(14.58%),1 vertebral body with type E leakage(2.08%),3vertebral bodies with type A combined with type D leakage(6.25%),1 vertebral body with type B combined with type D leakage(2.08%),2 vertebral bodies with type C combined with type D leakage(4.17%),and leakage type II(?2= 6.567,P = 0.767 > 0.05);in the group with no postoperative residual pain,there were 43 cases of balance(16.80%),61 cases of compensatory balance(23.83%),and 152 cases of balance(59.38%);In the postoperative residual pain group,there were 5 cases with balance,accounting for 11.90%,5 cases with compensation balance,accounting for 11.90%,and 32 cases with imbalance,accounting for76.19%,Barrey's method showed no statistical difference in residual pain after vertebroplasty(?2 = 4.50,P=0.105> 0.05).There were 4 vertebral bodies in the thoracic region(T4-T9),accounting for 8%,and 35 vertebral bodies in the thoracolumbar region(T10-L2),accounting for 70%,and 11 vertebral bodies in the lumbar region(L3-L5),accounting for 22%;in the group without residual pain after surgery,there were 48 vertebral bodies in the thoracic region(T4-T9),accounting for 13.41%,239 vertebral bodies in the thoracolumbar region(T10-L2),accounting for 66.76%,71 vertebral bodies in the lumbar region(L3-L5),accounting for 19.83%,and the fracture region(?2 = 1.178,P = 0.555 >0.05)had a statistically significant difference in whether residual pain occurred after vertebroplasty;there were 256 cases(360 vertebral bodies),72.27%,46 cases of doublevertebral body fracture,17.97%,20 cases of triple vertebral body fracture,and 7.81%,and 4cases of vertebral body fracture,and 1.56%.0.39%;postoperative residual pain group: 42cases(48 vertebrae),36 cases of single vertebral fracture(85.71%),6 cases of double vertebral fracture(14.29%).The number of fractured vertebrae(?2= 5.152,P = 0.280 >0.05)had a statistically significant difference in whether residual pain occurred after vertebroplasty;postoperative residual pain group had 42 cases,with a mean age of 74.16 ±9.17 years;postoperative no residual pain group had 256 cases,with a mean age of 74.17 ±9.98 years;age(t = 0.974,P= 0.344 > 0.05)had a statistically significant difference in whether residual pain occurred after vertebroplasty;postoperative residual pain group had 42 cases,with a mean femur bone density t =-2.042 ± 1.0576,with a statistically significant difference in whether residual pain occurred after vertebroplasty(t = 1.460,P = 0.149).The average bone mineral density t of vertebral body was-2.58 ± 1.21;there were 256 cases with no residual pain after operation,the average bone mineral density t of vertebral body was-2.68 ± 1.04,and the bone mineral density of vertebral body(t = 0.603,P= 0.547 > 0.05)had statistical difference on whether residual pain occurred after vertebroplasty;there were 42 cases with residual pain after operation,the average value of QCT of vertebral body was54.12 ± 9.76;there were 256 cases with no residual pain after operation,the average value of QCT of vertebral body was 55.01 ± 13.58,the average value of QCT of vertebral body(t =0.685 > 0.05)had statistical difference on whether residual pain occurred after vertebroplasty;there were 42 cases with residual pain after operation,the average value of QCT of femur(t= 73.49 ± 12.63,P= 0.055 > 0.05)had statistical difference on whether residual pain occurred after vertebroplasty,the average value of cement volume ratio was 19.99 ± 6.19;there were 256 cases with no residual pain after operation,the average value of bone volume ratio of femoral bone cement.The cement volume ratio(t =-1.758,P= 0.084 > 0.05)had a statistically significant difference in whether residual pain occurred after vertebroplasty;in the postoperative no residual pain group,the mean value of height recovery of fractured vertebral body was 8.28 ± 7.08;in the postoperative residual pain group,the mean value of height recovery of fractured vertebral body was 7.03 ± 7.37,and the recovery of vertebral fracture height(t = 1.055,P = 0.292 > 0.05)had a statistically significant difference in whether residual pain occurred after vertebroplasty;in the postoperative no residual pain group,the mean value of kyphosis correction was 2.00 ± 5.21;in the postoperative residual pain group,the mean value of kyphosis correction was 0.86 ± 5.64,and the degree of kyphosis correction(t = 1.305,P = 0.193 > 0.05)had no statistically significant difference in whether residual pain occurred after vertebroplasty.Conclusion:Bone cement failed to cover the fracture line,unilateral distribution of bone cement,preoperative pain type C are prone to postoperative residual pain. |
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