摘要
目的 比较局部强化与常规麻醉下经皮椎体成形术(PVP)治疗多节段急性症状性骨质疏松性胸腰椎骨折(m-ASOTLF)的疗效.方法 采用回顾性队列研究分析2021年1月至2022年12月西安交通大学附属红会医院收治的91例m-ASOTLF患者的临床资料,其中男36例,女55例;年龄55～80岁[(67.4±7.3)岁].美国麻醉医师协会(ASA)分级:Ⅰ级18例,Ⅱ级52例,Ⅲ级21例.损伤节段:T6～T1023例,T11～L2 47例,L3～L5 21例.患者均行PVP治疗.45例采用局部强化麻醉(强化麻醉组),46例采用局部常规麻醉(常规麻醉组).比较两组手术时间、术中出血量、术中心率、术中平均动脉压(MAP)、术中透视次数、骨水泥总注射量;术前,术后1 d、1个月及末次随访时视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI);术前,术后1、6及12 h简易精神状态量表(MMSE)评分;术前及术后1 d前缘椎体高度(AVH)、中央椎体高度(MVH)、椎体后凸角(VKA);骨水泥渗漏发生率.结果 患者均获随访12～20个月[(15.8±2.6)个月].两组手术时间、术中出血量、术中心率、术中MAP、术中透视次数及骨水泥总注射量差异均无统计学意义(P＞0.05).术前及末次随访时两组VAS、ODI差异均无统计学意义(P＞0.05).强化麻醉组术后1 d、1个月VAS分别为(2.5±0.4)分、(1.8±0.3)分,均低于常规麻醉组的(3.5±0.4)分、(2.0±0.5)分(P＜0.01);强化麻醉组术后1 d、1个月ODI分别39.8±3.3、26.5±5.0,均低于常规麻醉组的43.8±7.5、30.3±6.4(P＜0.01).两组术后各时间点VAS、ODI均较术前降低,且术后各时间点差异均有统计学意义(P＜0.05).两组术前,术后1、6及12 h MMSE评分差异均无统计学意义(P＞0.05).两组术后1、6 h的MMSE评分均较术前降低,且术后6 h的MMSE评分较术后1 h提高(P＜0.05),术后12 h的MMSE与术前差异无统计学意义(P＞0.05).术前两组AVH、MVH及VKA差异均无统计学意义(P＞0.05).强化麻醉组术后1 d的AVH、MVH分别为(22.4±4.2)mm、(22.7±3.7)mm,均高于常规麻醉组的(19.3±3.7)mm、(20.1±6.3)mm(P＜0.05 或0.01);强化麻醉组术后1 d的VKA为(13.9±3.7)°,低于常规麻醉组的(15.8±4.1)°(P＜0.05).两组术后1 d的AVH、MVH、VKA均较术前改善(P＜0.05).强化麻醉组骨水泥渗漏发生率为6.7％(3/45),低于常规麻醉组的21.7％(10/46)(P＜0.05).结论 与局部常规麻醉相比,局部强化麻醉下PVP治疗m-ASOTLF在术后早期缓解疼痛、改善脊柱功能、恢复椎体高度及减少骨水泥渗漏发生率等方面更具优势.
Abstract
Objective To compare the efficacy of percutaneous vertebroplasty(PVP)under enhanced regional and conventional anesthesia for multisegmental acute symptomatic osteoporotic thoracolumbar fractures(m-ASOTLF).Methods A retrospective cohort study was conducted to analyze the data of 91 patients with m-ASOTLF who were admitted to Honghui Hospital of Xi'an Jiaotong University from January 2021 to December 2022,including 36 males and 55 females,aged 55-80 years[(67.4±7.3)years].According to American Society of Anesthesiologists(ASA)classification system,18 patients were classified as grade Ⅰ,52 grade Ⅱ,and 21 grade Ⅲ.Injured segments included T6-T10 in 23 patients,T11-L2 in 47 and L3-L5 in 21.All the patients were treated with PVP,among whom 45 were given enhanced regional anesthesia(enhanced anesthesia group)and 46 regional conventional anesthesia(conventional anesthesia group).The following indicators were compared between the two groups:the operation time,intraoperative bleeding,intraoperative heart rate,intraoperative mean arterial pressure(MAP),number of intraoperative fluoroscopies,and total amount of bone cement injected;the visual analogue scale(VAS)and Oswestry dysfunction index(ODI)before surgery,at 1 day,1 month after surgery and at the last follow-up;the mini-mental state examination(MMSE)before surgery,at 1,6,and 12 hours after surgery;the anterior vertebrae height(AVH),middle vertebrae height(MVH),and vertebral kyphosis angle(VKA)before and at 1 day after surgery;the incidence of complications such as bone cement leakage.Results All the patients were followed up for 12-20 months[(15.8±2.6)months].There were no significant differences between the two groups in the operation time,intraoperative bleeding,intraoperative heart rate,intraoperative MAP,number of intraoperative fluoroscopies or total amount of bone cement injected(P＞0.05).No significant differences were found between the two groups in VAS or ODI before surgery and at the last follow-up(P＞0.05).The VAS scores in the enhanced anesthesia group were(2.5±0.4)points and(1.8±0.3)points at 1 day and 1 month postoperatively respectively,which were both lower than(3.5±0.4)points and(2.0±0.5)points in the conventional anesthesia group(P＜0.01).The ODI values in the enhanced anesthesia group were 39.8±3.3 and 26.5±5.0 at 1 day and 1 month postoperatively respectively,which were both lower than 43.8±7.5 and 30.3±6.4 in the conventional anesthesia group(P＜0.01).The VAS and ODI at all postoperative time points decreased in both groups compared with those before surgery,with significant differences among those at all postoperative time points(P＜0.05).There was no significant difference between the two groups in the MMSE scores before,at 1,6,and 12 hours after surgery(P＞0.05).The MMSE scores at 1 and 6 hours postoperatively were lower than that preoperatively in both groups(P＜0.05),and it was increased at 6 hours compared with that at 1 hour postoperatively(P＜0.05).There was no significant difference between the MMSE scores at 12 hours postoperatively and preoperatively in both groups(P＞0.05).The differences between the two groups in AVH,MVH,or VKA preoperatively were not statistically significant(P＞0.05).The AVH and MVH at 1 day postoperatively in the enhanced anesthesia group were(22.4±4.2)mm and(22.7±3.7)mm respectively,which were both higher than those in the conventional anesthesia group[(19.3± 3.7)mm and(20.1±6.3)mm](P＜0.05 or 0.01);the VKA at 1 day postoperatively in the enhanced anesthesia group was(13.9±3.7)°,which was lower than that in the conventional anesthesia group(15.8± 4.1)°(P＜0.05).The AVH,MVH,and VKA in both groups were all improved at 1 day postoperatively compared with those preoperatively(P＜0.05).The incidence of bone cement leakage in the enhanced anesthesia group was 6.7％(3/45),which was lower than 21.7％(10/46)in the conventional anesthesia group(P＜0.05).Conclusion Compared with conventional regional anesthesia,PVP under enhanced regional anesthesia for m-ASOTLF has more advantages in early postoperative pain relief,improvement of spinal function,restoration of vertebral height and reduction of bone cement leakage.
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