坐位局麻下行颈椎后路单开门椎管扩大成形术的临床应用  

Clinical study of cervical posterior single-door laminoplasty with siting position under local anesthesia

作　　者：崔新华 刘涛[3] 林东 王升 谢长伟 林栋 郭中帅 赵泽 CUI Xin-hua;LIU Tao;LIN Dong;WANG Sheng;XIE Chang-wei;CUO Zhong-shuai;ZHAO Ze;CHEN Chang-qing(Xinxiang Medical College,Xinxiang,Henan 453000,China;Department of Orthopaedics,the First Affiliated Hospital of Henan Polytechnic University,Jiaozuo,Henan 454000,China;Department of Orthopedics,Henan Provincial Peoples Hospital,Zhengzhou 450003,China)

机构地区：[1]新乡医学院,河南新乡453000 [2]河南理工大学第一附属医院骨科,河南焦作454000 [3]河南省人民医院骨科,郑州450003

出　　处：《医药论坛杂志》2024年第17期1798-1803,共6页Journal of Medical Forum

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20221011)。

摘　　要：目的比较局部麻醉下采取坐位以及全身麻醉下采取俯卧位进行颈椎后路单开门椎管扩大成形术的差异,探讨坐位局麻下行颈椎后路单开门椎管扩大成形术的临床应用价值。方法回顾性分析2014年1月—2022年2月河南理工大学第一附属医院93例行颈椎后路单开门椎管扩大成形术患者的病历资料,根据术中麻醉方式和体位分为坐位局麻组(37例)和俯卧位全麻组(56例)。比较两组患者之间的手术时间、术中出血量、术后并发症、住院费用、VAS评分和JOA评分;比较坐位局麻组患者术前和术中心率、血压。结果相比俯卧位全麻,坐位局麻下行颈椎后路单开门椎管扩大成形术,手术时间较短、术中出血少、住院费用显著减少,且术后转入ICU的发生率较低(P<0.05)。术后3月和1年坐位局麻组的VAS评分显著低于俯卧位全麻组(P<0.05);术后3月和1年坐位局麻组的JOA评分显著高于俯卧位全麻组(P<0.05)。结论坐位局麻下行颈椎后路单开门椎管扩大成形术具有缩短手术时间、减少术中出血、术后转入ICU发生率低、减少患者经济支出和负担等优势,为临床医生提供了一种安全高效经济的手术方式选择,尤其适用于不能或不愿接受全麻手术,经济困难的患者。Objective To observe the differences in cervical posterior single-door laminoplasty under local anesthesia with siting position and under general anesthesia with prone position,and explore the clinical application value of siting position local anesthesia in cervical posterior single-door laminoplasty.Methods The medical records of 93 patients undergoing cervical posterior single-door laminoplasty were retrospectively analyzed,and they were divided into sitting local anesthesia group(37 cases)and lying general anesthesia group(56 cases)according to the anesthesia method and position.Operation time,intraoperative blood loss,postoperative complications,hospitalization costs,VAS and JOA score were compared between these two groups.The preoperative and operative center rate and blood pressure were compared in the siting local anesthesia group.Results Compared with general anesthesia in prone position,cervical posterior single-door laminoplasty under sitting local anesthesia had shorter operation time,reduced intraoperative bleeding,significantly reduced hospitalization costs,and a lower incidence of postoperative transfer to ICU(P<0.05).The VAS score in the siting local anesthesia group was significantly lower than that in the lying general anesthesia group at 3 months and 1 year after surgery(P<0.05).The postoperative JOA score of the sitting local anesthesia group was significantly higher than that of the lying general anesthesia group at 3 months and 1 year after surgery(P<0.05).Conclusion With the advantages of shortening operation time,reducing intraoperative bleeding,low incidence of postoperative transfer to ICU,and reducing patients'economic expenditure and burden,posterior single door extended vertebral tube plasty under stting local anesthesia provides a safe,efficient and economical surgical option for clinicians,especially for patients who cannot or are unwilling to undergo general anesthesia and have financial difficulties.

关 键 词：颈椎退行性疾病 颈椎后路单开门椎管扩大成形术 坐位局麻 临床预后 

分 类 号：R687.3[医药卫生—骨科学]