超声引导下双侧竖脊肌阻滞对加速康复外科管理老年患者椎体后凸成形术疼痛疗效分析  

Analysis of effects of ultrasonic-guided bilateral erector spinal muscle block on accelerated rehabilitation surgery for management of painin elderly patients undergoing PKP

作　　者：黄晋旺 黄毓凯 彭杰 张文通 沈文晖 Huang Jinwang;Huang Yukai;Peng Jie;Zhang Wentong;Shen Wenhui(Department of Orthopedics,Xiamen Hospital,Zhongshan Hospital,Fudan University,Xiamen,Fujian,361015,P.R.China;Department of Orthopedics,Jinshan Hospital,Fudan University,Shanghai,201508,P.R.China;Department of Clinical Medicine,Xiamen Medical College,Xiamen,Fujian,361023,P.R.China)

机构地区：[1]复旦大学附属中山医院厦门医院骨科,福建厦门361015 [2]复旦大学附属金山医院骨科,上海201508 [3]厦门医学院临床医学系,福建厦门361023

出　　处：《老年医学与保健》2024年第2期514-518,共5页Geriatrics & Health Care

基　　金：厦门市科技计划指导项目(3502Z20209051);复旦大学附属中山医院厦门医院孵化课题(2020ZSXMYS15)。

摘　　要：目的分析加速康复管理下PKP术中超声引导下双侧竖脊肌平面阻滞治疗骨质疏松性椎体压缩骨折疼痛的治疗效果。方法对2018年5月-2020年6月复旦大学附属中山医院厦门医院骨科收治的73例骨质疏松性椎体压缩骨折(osteoporotic vertebralcompression fracture,OVCFs)患者临床资料进行回顾性性分析。所有患者均进行椎体后凸成形术(percutaneous vertebral kyphoplasty,PKP),按术中有无进行竖脊肌平面阻滞麻醉分为2组,其中A组(41例)术中在超声引导下双侧竖脊肌平面阻滞麻醉,B组(32例)未予竖脊肌平面阻滞麻醉干预。采用视觉模拟量表(visual analogue scale,VAS)评分及Oswestry功能障碍指数(Oswestry disability index,ODI)评分评估手术和神经阻滞干预的效果。每例患者分别记录术前、术中过床翻身、术中、术后过床翻身、术后第1天、术后1个月、术后3个月进行随访VAS评分和ODI评分。结果所有患者术后临床症状均得到有效的缓解,A组术中竖脊肌平面阻滞后翻身至手术床时VAS评分较B组明显减低[(5.34±1.42)分vs(7.53±0.95)分,P<0.001],A组术中VAS评分较B组明显减低[(6.68±0.72)分vs(7.75±0.92)分,P<0.001],A组术后过手术床翻身VAS评分较B组明显减低[(2.63±0.89)分vs(3.19±0.82)分,P<0.05],A组术后第1天VAS及ODI评分较B组明显减低[VAS:(1.71±0.60)分vs(2.38±0.91)分,P<0.001];[ODI:(19.39±2.65)分vs(25.28±5.15)分,P<0.001];A组与B组术后1个月VAS及ODI评分比较差异无统计学意义[VAS:(1.71±0.61)分vs(2.06±0.56)分,P<0.05];[ODI(19.68±3.86)分vs(22.66±4.32)分,P<0.005];A组与B组术后3月VAS及0DI评分比较差异无统计学意义[VAS:(1.95±0.50)分vs(2.09±0.73)分,P>0.05];[ODI:(19.32±3.17)分vs(19.72±3.48)分,P>0.05]。随访期间2组患者均未出现伤口感染或出血的并发症。结论PKP对骨质疏松性骨折患者术后临床症状均得到有效的缓解,手术翻身前进行竖脊肌神经阻滞未增加手术风险,且可有效缓解患�Objective To analyze the effects of ultrasound-guided bilateral erector spinae plane blockduring percutaneous kyphoplasty(PKP)in the treatment of pain induced by osteoporotic vertebral compression fracture(OVCFs)under accelerated rehabilitation management.Methods The clinical data of 73 patients with OVCFs admitted to Department of Orthopaedics,Xiamen Hospital,Zhongshan Hospital,Fudan University from May 2018 to June 2020 were retrospectively analyzed.All patients underwent PKP.They were divided into two groups according to whether or not erector spinae plane block anesthesia was performed during the operation.The group A(41 cases)received bilateral erector spinae plane block anesthesia under ultrasound guidance during the operation,and the group B(32 cases)did not receive erector spinae plane block anesthesia intervention.The Visual Analogue Scale(VAS)score and Oswestry Disability Index(ODI)score were used to evaluate the effects of surgery and nerve block intervention.TheVAS scores and ODI scores of patients were evaluated before the surgery,during the surgery,and on the first day,1 month and 3 months after the surgery,respectively.Results The clinical symptoms of all patients were effectively relieved after operation.The VAS score of the group A was significantly lower than that of the group B when the patients were turned over to operating bed after erector spinal plane block[(5.34±1.42)vs(7.53±0.95),P<0.001].The intraoperative VAS scoreof the group A was significantly lower than that of the group B[(6.68±0.72)vs(7.75±0.92),P<0.001].The postoperative VAS score of the group A was significantly lower than that of the group B when the patients were turned over to operating bed[(2.63±0.89)vs(3.19±0.82),P<0.05].The VAS score and ODI score of the group A on the first day after surgerywas significantly lower than thoseof the group B[VAS:(1.71±0.60)vs(2.38±0.91),P<0.001;ODI:(19.39±2.65)vs(25.28±5.15),P<0.001].There was no significant difference in VAS and ODI scores between bothgroups 1 month after surgery[

关 键 词：老年 加速康复 经皮椎体后凸成形术 椎体压缩骨折 疼痛管理 竖脊肌阻滞 

分 类 号：R687.3[医药卫生—骨科学]