局部麻醉侧卧位下经皮椎体成形术治疗骨质疏松性椎体压缩骨折  

Percutaneous vertebroplasty in lateral position for treatment of osteoporotic vertebral compression fractures under local anesthesia

作　　者：唐雪彬 王云清 曹贞国 李华 魏东 刘海棠 TANG Xue-bin;WANG Yun-qing;CAO Zhen-guo;LI Hua;WEI Dong;LIU Hai-tang(Dept of Orthopaedics,the Second Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221000,China)

机构地区：[1]徐州医科大学第二附属医院骨科,江苏徐州221000

出　　处：《临床骨科杂志》2023年第1期5-9,共5页Journal of Clinical Orthopaedics

基　　金：江苏省卫生健康委员会老年健康科研项目(编号:LK2021038);江苏省徐州市科技局科技计划项目(编号:KC21211)。

摘　　要：目的探讨局部麻醉侧卧位下经皮椎体成形术治疗骨质疏松性椎体压缩骨折的疗效。方法采用局部麻醉侧卧位下经皮椎体成形术治疗15例骨质疏松性椎体压缩骨折患者。记录双侧椎弓根穿刺成功率、手术时间、术中透视次数、骨水泥注入量、骨水泥渗漏情况,比较手术前后疼痛VAS评分、伤椎后凸角、伤椎前缘高度比,采用MacNab评定标准评估疗效。结果手术均顺利完成,无术中血管神经损伤、术后谵妄及认知障碍等并发症发生。双侧椎弓根穿刺成功率13/15,手术时间35~65(45.7±8.8)min,术中透视20~38(28.9±5.3)次,骨水泥注入量3.0~6.0(4.0±0.8)ml/椎。骨水泥渗漏4例。患者均获得随访,时间6~18个月。术后6个月采用MacNab评定标准评价疗效:优10例,良4例,可1例,优良率14/15。疼痛VAS评分、伤椎后凸角、伤椎前缘高度比:术后2 d及末次随访时均较术前改善(P<0.05),末次随访与术后2 d比较差异均无统计学意义(P>0.05)。结论局部麻醉侧卧位下经皮椎体成形术治疗骨质疏松性椎体压缩骨折能显著改善患者疼痛,疗效明确。Objective To investigate the efficacy of percutaneous vertebroplasty(PVP)in lateral position for treatment of osteoporotic vertebral compression fractures(OVCFs)under local anesthesia.Methods The 15 patients with OVCFs were treated with PVP in lateral position under local anesthesia.The success rate of bilateral pedicle puncture,operation time,intraoperative fluoroscopy times,the volume of bone cement injected,and the leakage rate of bone cement were recorded.The pain VAS,kyphotic angle of the injured vertebrae,and the height ratio of the anterior edge of the injured vertebra were compared before and after the operation.MacNab criteria was also used to evaluate the curative effect.Results All operations were successfully completed without complications such as intraoperative vascular and nerve injury,postoperative delirium and cognitive impairment.The success rate of bilateral pedicle puncture was 13/15,the operation time was 35~65(45.7±8.8)min,the intraoperative fluoroscopy times were 20~38(28.9±5.3)times,and the injection volume of bone cement per vertebra was 3.0~6.0(4.0±0.8)ml.There were 4 cases of bone cement leakage.All patients were followed up for 6~18 months.At 6 months after operation,the excellent-good rate was 14/15 based on MacNab criteria:10 patients excellent,4 patients good and 1 patient poor.The pain VAS,kyphotic angle of injured vertebra and height ratio of the anterior edge of the injured vertebra:at 2 d postoperation and the last follow-up,they were improved than the preoperation(P<0.05),and there was no significant difference between the last follow-up and 2 d postoperation(P>0.05).Conclusions PVP in lateral position under local anesthesia can significantly improve the pain of patients with OVCFs.The curative effect is clear.

关 键 词：侧卧位 经皮椎体成形术 椎体压缩骨折 局部麻醉监护 

分 类 号：R687.3[医药卫生—骨科学]