老年脊柱压缩骨折患者行椎体成形术围手术期服用阿司匹林手术疗效及安全性评估  

Efficacy and safety of perioperative aspirin administration in elderly patients with spinal compression fractures undergoing vertebroplasty

作　　者：张啟维[1] 尹自龙[1] 徐宏兵[1] 文良元[1] Zhang Qiwei;Yin Zilong;Xu Hongbing;Wen Liangyuan(Department of Orthopedics,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院骨科,国家老年医学中心,中国医学科学院老年医学研究院,100730

出　　处：《中华老年医学杂志》2021年第3期340-344,共5页Chinese Journal of Geriatrics

摘　　要：目的观察老年骨质疏松椎体骨折(OVF)患者行椎体成形术(VP)围手术期服用阿司匹林的安全性及对手术疗效影响.方法回顾性队列研究,分析2016年1月到2020年12月北京医院骨科136例行VP治疗OVF患者的临床资料,比较服用阿司匹林组(接受PVP术前服用阿司匹林,100 mg/d,并排除服用其他抗凝药物的患者)71例和未服用阿司匹林(对照组)65例患者临床资料、治疗效果、术中和术后并发症及血肿等发生情况.结果阿司匹林组与对照组术前、术后1周、末次随访中、镇痛药物评分、活动能力评分比较差异无统计学意义(均P>0.05).阿司匹林组术前、术后1周、末次随访VAS评分为(7.12±1.33)分、(2.37±1.01)分;镇痛药物评分为(3.01±0.95)分、(1.56±0.65)分、(1.61±0.57)分;活动能力评分为(2.75±0.53)分、(1.32±0.63)分、(1.44±0.52)分,差异有统计学意义(均P<0.01).阿司匹林组和对照组患者随访期间均未发生手术感染、大血管损伤、椎管内血肿神经脊髓压迫、肺栓塞等.阿司匹林组与对照组患者术中和术后出血量(12.0±3.5)ml比(11.0±3.6)ml(t=1.60)、单椎骨水泥注入量(4.5±1.9)ml比(4.0±1.7)ml(t=1.40)、骨水泥外溢14例(19.7%)比9(17.0%)(χ^(2)=0.15);神经根刺激症状3例(4.2%)比1例(1.9%)(χ^(2)=0.43);再骨折(含椎体及全身骨折)5例(7.0)比3例(5.7%)(χ^(2)=0.10);椎管外血肿8例(11.3%)比5例(9.4%)(χ^(2)=0.11),差异无统计学意义(均P>0.05).结论OVF行VP治疗患者服用阿司匹林术后疼痛评分、疼痛药物服用、活动能力较术前有明显改善.与未服用阿司匹林患者比较,手术疗效及安全性无差异.Objective To investigate the efficacy and safety of perioperative aspirin use in elderly patients with osteoporotic vertebral fractures(OVF)undergoing vertebroplasty(VP).Methods This was a retrospective cohort study.Clinical data of 136 OVF patients treated with VP in our department from Jan.2016 to Dec.2020 were analyzed.Differences in clinical data,treatment efficacy,intraoperative and postoperative complications and hematomas were compared between the aspirin group(n=71,receiving aspirin100 mg/d before VP and not taking other anticoagulant drugs)and the control group(n=65,not taking aspirin).Results There was no significant difference in the analgesic score or physical activity scale score between the two groups before,1 week after surgery and at the last follow-up(P>0.05).There were significant differences in the visual analog score(VAS),the analgesic score and the physical activity scale score before,1 week after surgery and at the last follow-up within the aspirin group(7.12±1.33,2.37±1.01 vs.2.63±1.04,3.01±0.95,1.56±0.65 vs.1.61±0.57,2.75±0.53,1.32±0.63 vs.1.44±0.52,P<0.01).No surgical site infection,injury of large vessels,intraspinal hematoma or pulmonary embolism was found in the aspirin group or the control group during the follow-up period.There was no difference in intraoperative or postoperative blood loss(12±3.5 ml vs.11.0±3.6ml,t=1.60),cement injection volume for a single vertebral body(4.5±1.9 ml vs.4.0±1.7 ml,t=1.40),cement spillage(14 cases or 19.7%vs.9 cases or 17.0%,χ^(2)=0.15),nerve root irritation(3 cases or 4.2%vs.1 case 1.9%,χ^(2)=0.43),re-fractures(5 cases 7.0 vs.3 cases 5.7%,χ^(2)=0.10)or spinal epidural hematoma(8 cases or 11.3%vs.5 cases or 9.4%,χ^(2)=0.11)between the aspirin group and the control group(all P>0.05).Conclusions In OVF patients taking perioperative aspirin,the postoperative pain score,pain medication administration and mobility are significantly improved after VP,compared with pre-treatment.Surgical efficacy and safety show no significant difference bet

关 键 词：椎体成形术 骨质疏松 脊柱骨折 阿司匹林 

分 类 号：R687.3[医药卫生—骨科学]