骨质疏松性椎体压缩性骨折PKP术后残余疼痛的防治策略  

Prevention and treatment strategies for residual pain after PKP for osteoporotic vertebral compression fractures

作　　者：郑礼 秦大平 李磊 杨芳芳 胡铁楠 权祯 张晓刚 高国栋 宋敏 徐斌 王志鹏 ZHENG Li;QIN Daping;LI Lei;YANG Fangfang;HU Tienan;QUAN Zhen;ZHANG Xiaogang;GAO Guodong;SONG Min;XU Bin;WANG Zhipeng(Clinical College of Traditional Chinese Medicine,Gansu University of Chinese Medicine,Lanzhou 730000,China;Department of Spinal Surgery,the Affiliated Hospital of Gansu University of Traditional Chinese Medicine,Lanzhou 730020,China)

机构地区：[1]甘肃中医药大学中医临床学院,甘肃兰州730000 [2]甘肃中医药大学附属医院脊柱外科,甘肃兰州730020

出　　处：《中国骨质疏松杂志》2024年第9期1348-1352,共5页Chinese Journal of Osteoporosis

基　　金：国家自然科学基金项目(82260941,81760873);甘肃省高等学校创新基金项目(2020A-073);兰州市人才创新创业项目(2021-RC-101);甘肃中医药大学科学研究与创新基金项目(2022KCZD-1)。

摘　　要：经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)能够在很大程度上缓解骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)疼痛,然而,许多患者在手术后仍然保留了一部分原始疼痛,甚至面临伤椎再骨折及邻近椎体骨折的风险。目前对于OVCF术后残余疼痛及相关并发症的危险因素存在不同的观点,但从术后残余应力的角度探讨其发病原因是一种新颖的思路与方法。残余应力是材料在去除外力后仍存在的内部应力。这种力的产生分为外部作用原因和材料内部组织结构不均匀的内因。它的存在可能导致椎体强度下降,力学性能降低,进而影响PKP术后OVCF患者的疼痛等症状。本文从残余应力的角度探讨了PKP术后OVCF患者疼痛等症状未能完全缓解的原因,并从骨水泥等的分布情况综述了应力集中的弊端以及如何预防和平衡残余应力。这样可以更好地保障PKP术后OVCF患者的生活质量。残余应力的提出,不仅为OVCF患者PKP术后提供了一个新的防治策略,也将为其他术后残余疼痛及其他症状提供新的理疗思路。以此作为出发点,这将是生物力学研究的一个新方向,并对临床具有不可忽视的作用。Percutaneous kyphoplasty(PKP)greatly relieves the pain after osteoporotic vertebral compression fracture(OVCF).However,many patients still retain some of the original pain after surgery,and are even at risk of refracture of the injured vertebra and adjacent vertebral fractures.At present,there are different views on the risk factors of postoperative residual pain and related complications of OVCF.It is a novel idea and method to explore the pathogenesis from the perspective of postoperative residual stress.Residual stress is the internal force that remains after the external force is removed from the material.The generation of this force can be divided into external causes and internal causes of uneven internal organizational structure of the material.Its presence may lead to decreased vertebral strength and mechanical properties,which in turn affect symptoms such as pain in OVCF patients after PKP.From the perspective of residual stress,this paper discusses the reasons why the pain and other symptoms of OVCF patients can not be completely relieved after PKP,and summarizes the disadvantages of stress concentration and how to prevent and balance residual stress from the distribution of bone cement.This can better guarantee the quality of life of OVCF patients after PKP.The proposed residual stress not only provides a new prevention and treatment strategy for OVCF patients after PKP,but also provides a new physiotherapy idea for other postoperative residual pain and other symptoms.Taking this as a starting point,it will be a new direction of biomechanics research and has a role that cannot be ignored in clinic.

关 键 词：骨质疏松症 压缩性骨折 生物力学 残余应力 椎体成形术 

分 类 号：R589.5[医药卫生—内分泌] R229[医药卫生—内科学]