椎旁神經根阻斷可成功控制壓迫性骨折的疼痛

Successful pain control with paravertebral block for patients suffering from vertebral compression fracture

背景：脊椎壓迫性骨折（Vertebral compression fracture， VCF）是一個常見造成疼痛的疾病，常見的原因是骨質疏鬆所引起。一旦產生脊椎壓迫性骨折，很可能造成病人的劇烈疼痛而影響日常生活，甚至引起嚴重的併發症。目前對於脊椎壓迫性骨折的治療尚未有明確的共識，本篇研究目的在了解脊椎旁神經阻斷（Paravertebral block，PVB）對於脊椎壓迫性骨折造成疼痛的治療成效。方法：我們在2017年七月至2018年六月間，在疼痛門診收集因脊椎壓迫性骨折造成嚴重疼痛（由脊椎X光攝影及沿著皮節分布的疼痛來確定診斷），接受超音波導引脊椎旁神經阻斷止痛的病人。病人回診後會根據疼痛緩解狀況決定是否再次注射。結果：一共收集了十位病人（年齡：77.247.9，男：女=4：6），接受總數17次脊椎旁神經阻斷（注射次數1.6±0.7，注射位置胸椎：腰椎=6：4）。從我們的追蹤發現脊椎旁神經阻斷可以有效地緩解病人的疼痛（VAS-8.5+1.2減為3.6+1.6，P<0.01）。結論：我們的資料顯示脊椎壓迫性骨折的病人可以用脊椎旁神經阻斷來降低疼痛，但仍須更進一步的對照研究來了解脊椎旁神經阻斷在治療脊椎壓迫性骨折疼痛中扮演的角色。

Background: Vertebral compression fracture (VCF) is a well-known, painful condition that leads to lifestyle dysfunctions. Previous studies have shown that VCF is caused by osteoporosis and may cause severe pain. However, few researches have focused on the effect of nerve blocks on VCF. Methods: We collected VCF patients confirmed by X ray with severe pain and dermatome symptoms from July 2017 to June 2018 and performed a paravertebral block (PVB) under sono-guidance for pain control. Results: 10 patients (Age: 77.227.9, M/F: 4/6) were collected from our pain clinic, and a total of 17 PVBs (injection time: 1.6+ 0.7, spinal location: T/L: 6:4) were performed for all patients at 3-28 day intervals according to their pain location and severity. These patients were asked to come back for pain evaluation. Our data demonstrated that PVB may result in less pain sensation in VCF patients. (VAS=8.5+ 1.2 to 3.6–1.6, P<0.01). Conclusion: Our data clearly demonstrated that PVB provided better pain control for VCF patients with dermatome pain distribution. Further well controlled studies are needed to confirm the role of PVB in patients with pain caused by VCF.