麻醉方式对椎体后凸成形术疗效影响的比较研究

Contrastive study of percutaneous kyphoplasty for treatment of osteoporotic vertebral compression fractures with general anaesthesia and local anesthesia

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OVCF86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。

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 （ ll0 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, there were 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. Comparision of anterior, middle vertebral body height, kyphosis angle of 2 groups before and after surgery, and t＇he 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 leakage rate, and subjective satisfaction with group A showed no significant difference. Conclusion PKP for OVCF of 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.