局部麻醉下经皮穿刺椎体成形术中推注骨水泥时疼痛的研究  

Pain during cement injection in percutaneous vertebroplasty under local anesthesia

作　　者：李骁腾 张怀栓[1] 吕丰姿 张华[1] 李宝田[1] 潘玉林[1] LI Xiaoteng;ZHANG Huaishuan;LV Fengzi;ZHANG Hua;LI Baotian;PAN Yulin(Orthopaedic spine II,Zhengzhou Orthopedic Hospital,Zhengzhou,Henan 450000,China;不详)

机构地区：[1]郑州市骨科医院脊柱骨科Ⅱ,河南450000 [2]河南省人民医院麻醉科,河南郑州450000

出　　处：《中国骨与关节损伤杂志》2024年第5期472-476,共5页Chinese Journal of Bone and Joint Injury

摘　　要：目的对局部麻醉经皮穿刺椎体成形术中推注水泥时疼痛的原因进行相关研究。方法回顾性分析自2021-10—2022-10诊治的104例因骨质疏松性椎体压缩性骨折行经皮穿刺椎体成形术且术中推注骨水泥时出现腰部疼痛者。根据术中推注骨水泥时疼痛VAS评分以及是否辅助止疼药物进行分组:A组(18例)术中疼痛VAS评分≥7分,术中因腰部疼痛无法保持平卧,静脉辅助止痛药物;B组(46例)术中疼痛VAS评分>4~<7分,术中因疼痛稍作休息后完成手术,未予药物干预;C组(40例)术中疼痛VAS评分≤4分,可耐受且不影响手术操作。比较三组骨密度、椎体压缩程度、发病时间、骨水泥注入量、疼痛VAS评分。结果三组在骨密度、椎体压缩程度、发病时间以及术前、术后即刻疼痛VAS评分方面比较,差异有统计学意义(P<0.05);在骨水泥注入量、术后1周疼痛VAS评分方面比较,差异无统计学意义(P>0.05)。结论对于骨质疏松程度轻、发病时间长、伤椎压缩程度较重以及术前疼痛耐受差的患者,在局部麻醉下行经皮穿刺椎体成形术推注骨水泥时,患者可能更容易出现腰部疼痛。虽然术中疼痛不会影响术后疗效,但是为预防术中疼痛给患者带来的不良就医体验,术前可根据相关影响因素提前评估预防。Objective To investigate the causes of pain during cement injection in percutaneous vertebroplasty under local anesthesia.Methods One hundred and four cases of osteoporotic vertebral compression fractures treated with percutaneous vertebroplasty from October 2021 to October 2022,with lower back pain during intraoperative injection of bone cement were retrospectively analyzed.According to the VAS score of pain during intraoperative injection of bone cement and whether painkillers were used,patients were divided into three groups:group A(18 cases)had a VAS score of≥7 for intraoperative pain,and patients who were unable to maintain a supine position due to lower back pain during surgery received intravenous painkillers;group B(46 cases)had a VAS score for intraoperative pain ranging from 4 to 7 points and the surgery was completed after a brief rest due to pain,and no medication intervention was given;group C(40 cases)had a VAS score of≤4 for intraoperative pain,but it was tolerable and did not affect the surgical procedure.The bone density,vertebral compression degree,onset time,amount of bone cement injection,and pain VAS score among three groups were compared.Results There was a statistically significant difference(P<0.05)among the three groups in terms of bone density,vertebral compression degree,onset time,and VAS score for preoperative and postoperative immediate pain;There was no statistically significant difference(P>0.05)in the amount of bone cement injection and VAS score of pain one week after operation.Conclusion For patients with mild osteoporosis,long onset time,severe vertebral compression,and poor preoperative pain tolerance,percutaneous vertebroplasty with bone cement injection under local anesthesia may be more prone to lower back pain.Although intraoperative pain does not affect postoperative efficacy,in order to prevent adverse medical experiences caused by intraoperative pain for patients,preoperative evaluation and prevention should be carried out based on relevant influencing factors.

关 键 词：椎体压缩性骨折 骨质疏松 椎体成形 术中疼痛 骨水泥 

分 类 号：R687.3[医药卫生—骨科学]