摘要
目的观察经皮椎体后凸成形术(PKP)术中使用椎体内局部麻醉对患者术中、术后的镇痛效果,探讨减少骨质疏松性椎体压缩性骨折(OVCF)患者术中、术后疼痛,改善手术体验和满意度的方法。方法选择2014年1月—2015年10月在宁波大学医学院附属鄞州医院骨科行PKP手术的84例OVCF患者的临床资料,随机分为空白组(A组)、利多卡因组(B组)、罗哌卡因组(C组),每组28例,在术中建立穿刺工作套管后B组及C组分别向椎体内注射1%盐酸利多卡因5 m L和1%盐酸罗哌卡因5 m L,A组不给药,记录术前、术中球囊扩张时、骨水泥注入时、术毕即刻、术后6 h、术后24 h患者的疼痛视觉模拟量表(VAS)评分,并进行统计学分析。术后评估患者对手术的满意度。结果术前3组一般资料及VAS评分比较差异无统计学意义(P>0.05)。术中、术后VAS评分进行两两比较,球囊扩张时和骨水泥注入时,B组、C组VAS评分均低于A组,差异具有统计学意义(P<0.05);术毕即刻VAS评分A组>B组>C组,且组间差异均具有统计学意义(P<0.05);术后6 h A组与B组间VAS评分差异无统计学意义(P>0.05),C组评分仍低于另两组且差异均具有统计学意义(P<0.05)。术后24 h 3组间VAS评分差异无统计学意义(P>0.05)。术后调查3组患者对"再次手术"的接受程度,3组间差异无统计学意义(P>0.05)。结论 PKP治疗OVCF,术中椎体内局部麻醉能有效缓解术中疼痛,改善患者手术体验,提高患者对手术的信任,且不影响手术临床效果。
Objective To reduce the pain of the patients with osteoporotic vertebral compression fracture（OVCF） and improve their surgical experience by observing intraoperative and postoperative analgesic effects of intraosseous anesthesia in percutaneous kyphoplasty（PKP）. Methods A total of 84 OVCF patients who were treated by PKP were selected from January 2014 to October 2015. The patients were randomly divided into the blank control group（group A）,lidocaine group（group B） and ropivacaine group（group C）. When the puncture channels were established in PKP,groups B and C were administrated with 5 m L of 1% lidocaine hydrochloride and 5 m L of ropivacaine hydrochloride,respectively,through intraosseous injection;while group A was not given any drugs. The visual analogue scale（VAS） scores were recorded as the observation indexes at the moment of pre-operation,intraoperative balloon expansion,injection of bone cement,immediately post-operation,postoperative 6 h,and postoperative 24 h. Patients＇ satisfaction on analgesic effects was evaluated after the operation. Results There were no significant differences between the 3 groups in preoperative general information and VAS score（P〈0.05）. Pair-wise comparison was carried out for intraoperative and postoperative VAS scores. VAS scores in group B and C were lower than that in group A at the moment of balloon expansion and injection of bone cement,and the differences were statistically significant（P〈0.05）. VAS scores of immediately post-operation were group A group B group C,and the differences were statistically significant（P〈0.05）. There was no statistical difference between group A and group B at postoperative 6 h in VAS scores（P〈0.05）,but there were statistical differences between group C and the former 2 groups（P〈0.05）. Scores of the 3 groups at postoperative 24 h showed no statistical difference（P〈0.05）. After operation,the patients were investigated for the acceptance of reoperation,and there were no significant differences between the 3 groups. Conclusion During PKP for OVCF patients,intraosseous anesthesia can effectively relieve the patient＇s intraoperative pain,and improve their operation experience,and improve their surgical to the operation,and does not affect the clinical effects of the operation.
出处
《脊柱外科杂志》
2017年第5期279-283,共5页
Journal of Spinal Surgery
关键词
老年人
胸椎
腰椎
骨质疏松
脊柱骨折
骨折
压缩性
经皮椎体后凸成形术
麻醉
局部
osteoporotic vertebral compression fracture（OVCF）
observing intraoperative
postoperative analgesic effects
intraosseous anesthesia
percutaneous kyphoplasty（PKP）
intraoperative balloon expansion
bone cement
