局麻下经皮椎体后凸成形术术中疼痛的临床研究

A clinical study of pain under the local anesthesia in percutaneous kyphoplasty

目的对经皮椎体后凸成形术的术中疼痛进行相关临床研究。方法选择68例椎体骨质疏松性压缩骨折患者,均为新鲜压缩骨折,完成72个椎体后凸成形术。手术均采用局麻下经皮椎体后凸成形术,均为单侧球囊穿刺。对术中穿刺、球囊扩张、骨水泥注射三个阶段患者疼痛进行评估和比较,同时观察术中的疼痛行为特征和生命体征。结果 59例(87%)患者术后疼痛出现明显改善,术中疼痛出现率为82%。手术前后VAS均值分别为8.1±1.2和3.1±1.4,穿刺VAS均值为7.6±1.2,球囊扩张VAS均值为8.7±0.9,骨水泥注射VAS均值为8.1±0.7。最疼痛比率:穿刺占18%,球囊扩张占53%,骨水泥注射占29%。球囊扩张时的疼痛程度与穿刺和骨水泥注射的疼痛程度相比有统计学差异(P<0.05)。术中疼痛的发生对临床效果无影响。结论对于椎体后凸成形术,多数患者会出现术中疼痛。尽管术中疼痛的出现不会影响椎体后凸成形术的临床疗效,但是我们还是应该对它给予足够的重视和处理。

Objective To determine the incidence of pain during surgery for osteoporosis vertebral body compress fracture （OVCF） by using percutaneous kyphoplasty （PKP）. Methods Between September 2009 and September 2011, 68 patients with fresh OVCF were treated by PKP. 72 vertebral bodies were treated by PKP. PKP were all applied unilateral balloon puncture along with local anesthesia. The pain on the 3 stages of needle placing, balloon expansion and cement injection was evaluated and analyzed. Meanwhile, features of the pain behavior and vital signs during surgery were observed. The VAS scores of different stages were recorded [visual analog scale： from 0 （no pain） to 10 （most severe pain）]. Results Among the 68 patients treated for osteoporotic fractures by using PKP, 59 patients had remarkable pain relief postoperatively, taking up 87%. The occurrence rate of the pain during surgery was 82%. The mean VAS scores were 8.1±1.2 preoperatively and 3.1±1.4 postoperatively. The mean VAS score of puncture was 7.6± 1.2. The mean VAS score of balloon expansion was 8.7＋0.9. The mean VAS score of cement injection was 8.1 ±0.7. Most severe pain rate： needle placing took up 18%, balloon expansion 53%, and cement injection 29%. Statistic differences existed between the pain degree of balloon expansion and the pain degree of needle placing and cement injection （P〈0.05）. The occurrence of the pain during surgery had no influence on the clinical results. Conclusions For most patients, pain happens during PKP. Although the occurrence of pain during surgery has no influence on the clinical results of PKP, we should pay sufficient attention to it and its treatment in the future.