目的 评估2种不同麻醉方式对经皮椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩性骨折(OVCF)疗效的影响.方法 本组OVCF 86例(110椎),随机分成2组:A组43例(54椎),男12例,女31例,年龄56～76岁,平均65.8岁.胸腰段后凸17°～39°(25.5°±6.4°),局麻下行PKP.B组43例(56椎),男12例,女31例,年龄58-78岁,平均67.4岁.胸腰段后凸19°～36°(27.6°±5.9°),全麻下行PKP.术前骨密度检查示,均存在中、重度骨质疏松.两组手术由同一组医师完成,术后均予密盖息行抗骨质疏松治疗.比较2组手术前后椎体前、中份高度,脊柱后凸角度,术中神经并发症发生率,骨水泥渗漏率,术中出血量,主观满意度(VAS评分),手术时间,住院时间等指标.评估2种麻醉方法对PKP疗效的影响.结果 两组年龄、性别构成,术前胸腰段后凸角度无统计学差异(P>0.05).术前A组椎体前、中份高度分别为原高度的(58.2±15.3)%和(53.4±18.5)%,术后为(83.2±22.4)%和(76.3±24.3)%(P<0.01).术前B组椎体前、中份高度分别为原高度的(56.5±16.3)%和(54.6±17.2)%,术后为(88.3±20.7)%和(83.5±21.6)%(P<0.01).B组椎体复位效果优于A组(P<0.05).A组后凸矫正至术后的17.5°±6.3°(P<0.01).B组后凸矫正至术后的13.2°±6.8°(P<0.01).B组后凸改善优于A组(P<0.05).A组无1例发生神经并发症,骨水泥渗漏4椎(7.4%),手术时间(32.5±7.5)min/椎,住院时间(5.2±1.6)d,术中出血量(26.5±4.3)ml,术前VAS评分(8.5±2.3)分,术后2d降低到(2.4±1.3)分.B组发生神经并发症2例(4.7%),骨水泥渗漏4椎(7.1%),手术时间(42.3±8.2)min/椎,住院时间(7.1±2.1)d,术中出血量(27.2±5.2)ml,术前VAS评分(8.3±2.5)分,术后2d降低到(2.5±1.5)分.B组神经并发症,手术时间、住院时间均高于A组(P<0.05).术中出血量、骨水泥渗漏率、主观满意度与A组相比无显著性差异(P>0.05).结论 全麻下行PKP与局麻相比,前者可获得更为满意的椎体复位效果,但神经并发症发生风险较后者增多,且手术、住院时间延长.术中出血量、骨水泥渗漏率、主观满意度与后者相似.
目的 評估2種不同痳醉方式對經皮椎體後凸成形術(PKP)治療骨質疏鬆性椎體壓縮性骨摺(OVCF)療效的影響.方法 本組OVCF 86例(110椎),隨機分成2組:A組43例(54椎),男12例,女31例,年齡56～76歲,平均65.8歲.胸腰段後凸17°～39°(25.5°±6.4°),跼痳下行PKP.B組43例(56椎),男12例,女31例,年齡58-78歲,平均67.4歲.胸腰段後凸19°～36°(27.6°±5.9°),全痳下行PKP.術前骨密度檢查示,均存在中、重度骨質疏鬆.兩組手術由同一組醫師完成,術後均予密蓋息行抗骨質疏鬆治療.比較2組手術前後椎體前、中份高度,脊柱後凸角度,術中神經併髮癥髮生率,骨水泥滲漏率,術中齣血量,主觀滿意度(VAS評分),手術時間,住院時間等指標.評估2種痳醉方法對PKP療效的影響.結果 兩組年齡、性彆構成,術前胸腰段後凸角度無統計學差異(P>0.05).術前A組椎體前、中份高度分彆為原高度的(58.2±15.3)%和(53.4±18.5)%,術後為(83.2±22.4)%和(76.3±24.3)%(P<0.01).術前B組椎體前、中份高度分彆為原高度的(56.5±16.3)%和(54.6±17.2)%,術後為(88.3±20.7)%和(83.5±21.6)%(P<0.01).B組椎體複位效果優于A組(P<0.05).A組後凸矯正至術後的17.5°±6.3°(P<0.01).B組後凸矯正至術後的13.2°±6.8°(P<0.01).B組後凸改善優于A組(P<0.05).A組無1例髮生神經併髮癥,骨水泥滲漏4椎(7.4%),手術時間(32.5±7.5)min/椎,住院時間(5.2±1.6)d,術中齣血量(26.5±4.3)ml,術前VAS評分(8.5±2.3)分,術後2d降低到(2.4±1.3)分.B組髮生神經併髮癥2例(4.7%),骨水泥滲漏4椎(7.1%),手術時間(42.3±8.2)min/椎,住院時間(7.1±2.1)d,術中齣血量(27.2±5.2)ml,術前VAS評分(8.3±2.5)分,術後2d降低到(2.5±1.5)分.B組神經併髮癥,手術時間、住院時間均高于A組(P<0.05).術中齣血量、骨水泥滲漏率、主觀滿意度與A組相比無顯著性差異(P>0.05).結論 全痳下行PKP與跼痳相比,前者可穫得更為滿意的椎體複位效果,但神經併髮癥髮生風險較後者增多,且手術、住院時間延長.術中齣血量、骨水泥滲漏率、主觀滿意度與後者相似.
목적 평고2충불동마취방식대경피추체후철성형술(PKP)치료골질소송성추체압축성골절(OVCF)료효적영향.방법 본조OVCF 86례(110추),수궤분성2조:A조43례(54추),남12례,녀31례,년령56～76세,평균65.8세.흉요단후철17°～39°(25.5°±6.4°),국마하행PKP.B조43례(56추),남12례,녀31례,년령58-78세,평균67.4세.흉요단후철19°～36°(27.6°±5.9°),전마하행PKP.술전골밀도검사시,균존재중、중도골질소송.량조수술유동일조의사완성,술후균여밀개식행항골질소송치료.비교2조수술전후추체전、중빈고도,척주후철각도,술중신경병발증발생솔,골수니삼루솔,술중출혈량,주관만의도(VAS평분),수술시간,주원시간등지표.평고2충마취방법대PKP료효적영향.결과 량조년령、성별구성,술전흉요단후철각도무통계학차이(P>0.05).술전A조추체전、중빈고도분별위원고도적(58.2±15.3)%화(53.4±18.5)%,술후위(83.2±22.4)%화(76.3±24.3)%(P<0.01).술전B조추체전、중빈고도분별위원고도적(56.5±16.3)%화(54.6±17.2)%,술후위(88.3±20.7)%화(83.5±21.6)%(P<0.01).B조추체복위효과우우A조(P<0.05).A조후철교정지술후적17.5°±6.3°(P<0.01).B조후철교정지술후적13.2°±6.8°(P<0.01).B조후철개선우우A조(P<0.05).A조무1례발생신경병발증,골수니삼루4추(7.4%),수술시간(32.5±7.5)min/추,주원시간(5.2±1.6)d,술중출혈량(26.5±4.3)ml,술전VAS평분(8.5±2.3)분,술후2d강저도(2.4±1.3)분.B조발생신경병발증2례(4.7%),골수니삼루4추(7.1%),수술시간(42.3±8.2)min/추,주원시간(7.1±2.1)d,술중출혈량(27.2±5.2)ml,술전VAS평분(8.3±2.5)분,술후2d강저도(2.5±1.5)분.B조신경병발증,수술시간、주원시간균고우A조(P<0.05).술중출혈량、골수니삼루솔、주관만의도여A조상비무현저성차이(P>0.05).결론 전마하행PKP여국마상비,전자가획득경위만의적추체복위효과,단신경병발증발생풍험교후자증다,차수술、주원시간연장.술중출혈량、골수니삼루솔、주관만의도여후자상사.
Objective To evaluate and compare clinical results of percutaneous kyphoplasty ( PKP) with general anaesthesia and local anesthesia performed on patients of osteoporotic vertebral compression fractures (OVCF).Methods 86 cases of OVCF (110 vertebras) in Nanjing first hospital, which were divided randomly into 2 groups: group A (n=43) , among which, there were 12 male and 31 female.The average age was 65.8 years old ( ranging from 56 to 76).The thoracolumbar kyphosis was 25.5 degree ( ranging from 17 to 39).Group A were performed PKP with local anesthesia; group B (n =43) , among which, therewere 12 male and 31 female.The average age was 67.4 years old (ranging from 58 to 78).The thoracolumbar kyphosis was 27.6 degree (ranging from 19 to 36).Group B were performed PKP with general anaesthesia.Preoperative examination showed that bone mineral density of group A and B was moderate and severe osteoporosis.The operation of group A, B was completed by the same team of doctors; patients were therefore correspondingly Miacalcic line of anti-osteoporosis treatment.Comparison of anterior, middle vertebral body height, kyphosis angle of 2 groups before and after surgery, and the incidence of intraoperative neurological complications, bone cement leakage rate, operative time, blood loss, subjective satisfaction ( VAS score) , length of stay and so on.Assessment of two kinds of anesthesia methods on the curative effect of PKP.Results Group A and B of age, gender composition, and preoperative thoracolumbar kyphosis angle was of no significant difference.Group A of preoperative anterior, middle vertebral body height were (58.2 ± 15.3 ) %,and ( 53.4 ± 18.5 ) % respectively, postoperative ( 83.2 ± 22.4) % and (76.3 ± 24.3 ) % .Group B that of preoperative (56.5±16.3)%, and ( 54.6 ± 17.2 ) % respectively, postoperative (88.3 ±20.7)% and (83.5 ±21.6)%.Vertebra reduction of group B was more effective than group A.Group A of postoperative kyphosis angle corrected to 17.5°± 6.3°, that of Group B corrected to 13.2°±6.8°.Group B of vertebral kyphosis was better than group A.Group A of no case of neurological complications, 4 vertebral bone cement leakage (7.4%), average operative time 32.5min, length of stay 5.2 days, blood loss 26.5ml, preoperative VAS score 8.5, after two days down to 2.4.Group B of 2 cases of neurological complications, 4 vertebral bone cement leakage (7.1% ) , average operative time 42.3 min, length of stay 7.1 days, blood loss 27.2 ml, preoperative VAS score 8.3, after two days down to 2.5.Group B of neurological complications, operative time, and hospitalization time were higher than group A.Blood loss, bone cement general anaesthesia compared with local anesthesia, the former can provide a better vertebra reduction, but the risk of neurological complications is more than the latter, and the time of operation, hospitalization is longer than the latter, and the blood loss, bone cement leakage rate, subjective satisfaction is similar to the latter.
