A prospective control study on the block of posterior branch of spinal nerve combined with percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fractures

doi:10.3969/j.issn.1009-976X.2023.02.008

Abstract

Abstract: Objective To explore the therapeutic effect and safety of the combined application of percutaneous kyphoplasty （PKP）and posterior spinal nerve root block on patients with osteoporotic vertebral compression fracture （OVCF）. Methods A total 103 patients diagnosed with OVCF in the Department of Orthopedics of Jieyang People's Hospitalfrom October 2021 to October 2022, were included in this study. The patients were divided randomly into PKP group （n=51） and PKP+block group （n=52）. The baseline data including age, gender, bone mineral density and surgical segments were collected and recorded and the clinical function scale evaluation was measured and compared between two groups, including Oswestry Disability Index （ODI）, Barthel scale （MBI） and visual analog scale （VAS） in pre-operation, 1 daypostoperatively （POD1）, 7 days postoperatively （POD7） and 3 months postoperatively. Results There were no significant differences in age, bone mineral density, ODI, MBI and VAS between（all P values > 0.05）. On the POD1, the ODI, MBI and VAS score in PKP+block group weresuperior to that of PKP group （all P values < 0.05）. On the POD7, the VAS and ODI of PKP+block group were better than that of PKP group （P < 0.05）. And the VAS, ODI and MBI of PKP+block group were also better than that of PKP group in the 3 months after operation （all P values < 0.05）. Conclusion This study showed that in the patients with OVCF, surgical procedure of PKP+block was superior to PKP alone in short-term and long-term effects and the safety.

Key words: osteoporotic vertebral compression fracture, osteoporosis, posterior spinal nerve root block, percutaneous kyphoplasty

摘要： 目的探索经皮穿刺球囊扩张椎体后凸成形术（PKP）及与脊神经后支阻滞联合使用对骨质疏松性椎体压缩性骨折（OVCF）的治疗效果,为此类骨折提供更安全且有效的治疗方案。方法本研究分析2021年10月至2022年10月期间于广东省揭阳市人民医院骨科就诊的103例诊断为OVCF的患者,采用随机数表法将其分为PKP组和PKP联合脊神经后支阻滞组（即PKP+阻滞组）,比较两组之间基线资料（年龄、性别、骨密度、手术节段）,比较术前、术后1天、术后7天及术后3个月的临床功能量表评估（VAS评分、ODI评分、MBI评分）等指标。结果与PKP组相比较,PKP+阻滞组术前的资料（年龄、骨密度、VAS评分、ODI评分、MBI评分）等指标无统计学差异（P> 0.05）;术后第1天评估中,PKP+阻滞组的临床量表评估（VAS评分、ODI评分、MBI评分）均优于PKP组（P< 0.05）;术后第7天评估中,PKP+阻滞组的临床量表评估（VAS评分、ODI评分）优于PKP组（P< 0.05）;术后3个月评估中,PKP+阻滞组的临床量表评估（VAS评分、ODI评分、MBI评分）也均优于PKP组（P< 0.05）。结论针对OVCF患者的治疗,不论是短期还是长期的效果,PKP+阻滞组均优于PKP组,提示脊神经后支阻滞联合经皮穿刺球囊扩张椎体后凸成形术是治疗OVCF安全且更为有效的治疗方案。

关键词: 骨质疏松性椎体压缩性骨折, 骨质疏松症, 脊神经后支阻滞, 经皮穿刺球囊扩张椎体后凸成形术

CLC Number:

R683.2

LI Tian, CHEN Tai-qiu, HONG Quan, LIN Jia-yang, LIN Ke-xin, LIN Ben-dan. A prospective control study on the block of posterior branch of spinal nerve combined with percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fractures[J]. Lingnan Modern Clinics In Surgery, 2023, 23(02): 145-151.

李钿, 陈太秋, 洪全, 林加阳, 林可新, 林本丹. 脊神经后支阻滞联合椎体后凸成形术治疗骨质疏松性椎体压缩性骨折的前瞻性对照研究[J]. 岭南现代临床外科, 2023, 23(02): 145-151.

References

[1] Compston JE, McClung MR, Leslie WD. Osteoporosis[J]. Lancet, 2019, 393(10169): 364-376.
[2] Cui L, Chen L, Xia W, et al.Vertebral fracture in postmenopausal Chinese women: a population-based study[J]. Osteoporos Int, 2017, 28(9): 2583-2590.
[3] Si L, Winzenberg TM, Jiang Q, et al.Projection of osteoporosis-related fractures and costs in China: 2010-2050[J]. Osteoporos Int, 2015, 26(7): 1929-1937.
[4] Boonen S, Van Meirhaeghe J, Bastian L, et al.Balloon kyphoplasty for the treatment of acute vertebral compression fractures: 2-year results from a randomized trial[J]. J Bone Miner Res, 2011, 26(7): 1627-1637.
[5] Wang B, Zhao CP, Song LX, et al.Balloon kyphoplasty versus percutaneous vertebroplasty for osteoporotic vertebral compression fracture: a meta-analysis and systematic review[J]. J Orthop Surg Res, 2018, 13(1): 264.
[6] Dohm M, Black CM, Dacre A, et al.A randomized trial comparing balloon kyphoplasty and vertebroplasty for vertebral compression fractures due to osteoporosis[J]. AJNR Am J Neuroradiol, 2014, 35(12): 2227-2236.
[7] Li Y, Yue J, Huang M, et al.Risk factors for postoperative residual back pain after percutaneous kyphoplasty for osteoporotic vertebral compression fractures[J]. Eur Spine J, 2020, 29(10): 2568-2575.
[8] Bogduk N, MacVicar J, Borowczyk J. The pain of vertebral compression fractures can arise in the posterior elements[J]. Pain Med, 2010, 11(11): 1666-1673.
[9] Ohtori S, Yamashita M, Inoue G, et al.L2 spinal nerve-block effects on acute low back pain from osteoporotic vertebral fracture[J]. J Pain, 2009, 10(8): 870-875.
[10] Park KD, Jee H, Nam HS, et al.Effect of medial branch block in chronic facet joint pain for osteoporotic compression fracture: one year retrospective study[J]. Ann Rehabil Med, 2013, 37(2): 191-201.
[11] Xu JJ, Tang XT, Yang J, et al.The Effect of Medial Branch Block on Postoperative Residual Pain Relieve After Percutaneous Kyphoplasty: A Randomized Controlled Trial With 12-Month Follow-up[J]. Pain Physician, 2021, 24(7): E1059-E1066.
[12] Chandra RV, Maingard J, Asadi H, et al.Vertebroplasty and Kyphoplasty for Osteoporotic Vertebral Fractures: What Are the Latest Data?[J]. AJNR Am J Neuroradiol, 2018, 39(5): 798-806.
[13] Wang H, Sribastav SS, Ye F, et al.Comparison of Percutaneous Vertebroplasty and Balloon Kyphoplasty for the Treatment of Single Level Vertebral Compression Fractures: A Meta-analysis of the Literature[J]. Pain Physician, 2015, 18(3): 209-222.
[14] Belkoff SM, Mathis JM, Jasper LE, et al.The biomechanics of vertebroplasty. The effect of cement volume on mechanical behavior[J]. Spine (Phila Pa 1976), 2001, 26(14): 1537-1541.
[15] Garfin SR, Yuan HA, Reiley MA.New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures[J]. Spine (Phila Pa 1976), 2001, 26(14): 1511-1515.
[16] Mitra R, Do H, Alamin T, et al.Facet pain in thoracic compression fractures[J]. Pain Med, 2010, 11(11): 1674-1677.
[17] Beaman DN, Graziano GP, Glover RA, et al.Substance P innervation of lumbar spine facet joints[J]. Spine (Phila Pa 1976). 1993, 18(8): 1044-1049.
[18] Kim DJ, Yun YH, Wang JM.Nerve-root injections for the relief of pain in patients with osteoporotic vertebral fractures[J]. J Bone Joint Surg Br, 2003, 85(2): 250-253.