The Analysis Of Pain Relief Mechanism After Percutaneous Vertebroplasty

Objective: Percutaneous Vertebroplasty was used to treat vertebral hemangiomas for the first time in 1987,its field of surgical treatment was ever-expanding with the development and technological advances, it is used in osteoporosis or other non-infectious factors of vertebral compression fractures Currently, its pain relief effect has been recognized by everyone, especially in the treatment of osteoporotic vertebral compression fracture cases, the pain relief effect is significant, it was reported that the Pain relief effect could reach more than 90%, Newly developed percutaneous vertebral kyphosis was commonly used in angioplasty surgery as a clinical method, has been also shown to have a good effect of pain relief, It is based on the type of percutaneous vertebroplasty and use of the balloon in the vertebral body of compression to expand, the vertebral body height has been restored, and then injectied the bone cement (methyl methacrylate) into the vertebral body, filling the cavity, so that make the compression vertebral successful reduction, despite the clinical effect is very clear, However, the specific pain relief mechanism have different opinions, The purpose of this Subject is to study and analyze the mechanism of pain relife through clinical cases.Method: Take our department 30 cases, which have osteoporotic vertebral compression fractures from February 2008-August 2009, detailed physical examination and imaging examintion before opretion, indications for surgery strictly, Inclusion criteria: more than 60 year,s of age, a clear imaging of osteoporosis vertebral compression fracture, including fresh and old fractures, vertebral body leading and trailing edge no obvious fracture, non-allergic; Exclusion criteria: less than 60 year,s of age, severe vertebral compression fracture associated with vertebral serious symptoms and with nerve compression or injury, no imaging of osteoporosis, bone normal, allergy. Vertebral fracture was focused on T7-L3, in which a single vertebral compression fractures 11 cases, 19 cases of multiple vertebral fractures, a total of 50 vertebraes, the bone cement injection volume was 1-5ml. divided all patients into small dose group and conventional dose group according the volume of injection of bone cement and the degree of balloon, here's small dose and conventional dose group are not based on the size of the amount of bone cement group, but according to the relationship between the amount of bone cement and the degree of balloon inflation, is a relative value. Small dose group, the amount of bone cement slightly is less than the balloon inflation, the conventional dose group is equal to or slightly larger than the balloon inflation. using statistical methed to analys the small dose group and conventional dose group VAS scores of the preoperative and postoperative, comparing the efficacy of two group in pain relief; the preoperative and postoperative X-ray was measured the vertebral height restoration to all patients, Vertebral body height restoration is less than 5mm named the A group, B group was greater than 5mm, The two groups preoperative and postoperative of the VAS scores were analyzed using statistical method, comparing the efficacy of two groups in pain relief. Patients were followed up to observe long-term efficacy. With each group preoperative and postoperative VAS scores; postoperative vertebral height restoration of the value and intraoperative surgical operation to explore for the reasons of pain relief.Results:1 According to all the patients preoperative and postoperative VAS scores, using statistical methed to analysis, except for 1 patient no improvement of clinical symptom (it is rejected when we are analyzing), and the remaining patients with pain symptom improved significantly.2 A total of 17 cases of Small dose group, the average score of preoperative was 8.296±0.201, the average score of Postoperative was 1.859±0.240, a total of 12 patients in conventional dose group, the average score of preoperative was 8.483±0.940, The average score of postoperative was 1.350±0.762, the two groups preoperative and postoperative for statistical analysis (P <0.05) differences were significant, indicating that Small dose of bone cement can achieve clinical effects.3 According to the value of restoration of vertebral height of the two groups were divided into group A (<5mm) and B group (> 5mm), in which patients A group: total of 18 cases, the average vertebral height restoration is 3.686±0.740mm, B group: a total of 12 patients Cases, the average recovery of vertebral height 6.433±0.730mm, to evaluate the analgesic effect of the two groups, two groups of vertebral height restoration have significant differences but have no significant difference in Postoperative analgesic effect (P>0.05), so surgery should not be excessively pursuit to the vertebral body height restoration and increase the amount of bone cement injectionConclusion: the cause of pain relief of Percutaneous vertebroplasty is not only the effect of the thermal of bone cement, stable line of force, but also mainly is due to the surgery for decompression of the vertebral body vertebral congestion, discharge of metabolites, have no relationship with the vertbral body and bone cement which had been injected, we should not be excessively pursuited of vertebral height restoration in surgery.The effect of postoperative and the choice of surgical indications,the skills of surgical operations are closely related.