经皮椎体强化联合局部神经阻滞治疗椎体压缩骨折远处疼痛的效果

Effects of percutaneous vertebral augmentation combined with local nerve block in the treatment of distant pain of vertebral compression fracture

目的 分析椎体强化联合局部神经阻滞治疗椎体压缩骨折远处疼痛的治疗效果。方法 对2016年1月至2016年12月北京协和医院骨科收治的41例骨质疏松性椎体压缩骨折伴远处疼痛患者进行回顾性分析,其中女性35例,男性6例,患者平均年龄(74.15±2.62)岁。所有患者均进行椎体后凸成形术,按术后有无进行椎旁神经阻滞及竖脊肌局部麻醉分为两组,其中A组(19例)术中或术后予以椎旁神经阻滞或竖脊肌局部麻醉,B组(22例)未予椎旁神经阻滞或竖脊肌局部麻醉干预。每例患者分别于术后2周、术后3个月进行随访,手术前、后均拍摄胸(腰)椎体正侧位X线片并测量相关指标。采用视觉模拟量评(visual analogue scale,VAS)评分及Oswestry功能障碍指数(oswestry disability index, ODI)评分评估手术和神经阻滞干预的效果。结果 所有患者术后临床症状均得到有效的缓解,予以椎旁神经阻滞或竖脊肌局部麻醉患者的手术时间与未予封闭治疗的手术时间比较,差异无统计学意义[(42.74±5.03)min vs.(40.59±7.21)min, P = 0.906),A组术后第1天VAS及ODI评分较B组明显减低(VAS:1.63±0.60 vs. 2.68±0.78, P <0.001;ODI:19.05±6.27 vs. 27.18±8.09, P =0.001),A组与B组术后2周VAS比较差异无统计学意义(2.32±0.48 vs. 2.55±0.67, P >0.05),A组术后2周ODI评分低于B组(21.79±4.70 vs. 25.73±6.30, P =0.043)。A组与B组术后3个月VAS差异有统计学意义(2.00±0.58 vs. 2.59±0.67, P =0.007),术后3个月ODI评分差异无统计学意义( P >0.05)。随访期间两组患者均未出现伤口感染或出血的并发症。结论 对伴有责任椎体远处疼痛的椎体压缩骨折患者,手术前后进行椎旁神经阻滞或竖脊肌局部麻醉并未增加手术风险和手术时间,且可有效缓解患者术后短期局部疼痛,值得临床推广。

Objective To analyze the efficacy of vertebral augmentation with local nerve block in the treatment of vertebral compression fracture with distant pain. Methods This is a retrospective analysis of 41 osteoporotic vertebral compression fracture patients with distant pain who were admitted to Orthopedics Department, Peking Union Medical College Hospital from January 2016 to December 2016, including 35 females and 6 males, with an average age of (74.15± 2.62)years. All patients were treated with vertebral by phoplasties. The patients were divided into two groups according to whether they accepted paravertebral block or erector spinae local anesthesia. 19 patients underwent paravertebral block or erector spinae local anesthesia intraoperatively, and that was group A. Group B (22 cases) did not accept paravertebral block or erector spinae local anesthesia. X-ray films of the thoracic and lumbar vertebral body were taken before and after the operation and the relevant indicators were measured. We performed follow-up (1 day, 2 weeks, and 3 months) after surgery. The visual analog scale (VAS) score and Oswestry dysfunction index (ODI) questionnaire score were used to evaluate the effects of surgery and anesthesia intervention. Results All patients had effective clinical remission after surgery. There was no significant difference in operation time between group A and group B[(42.74±5.03)min vs.(40.59±7.21)min, P =0.906]. The VAS and ODI score of the group A on the first day after surgery were significantly lower than those of group B (VAS 1.63±0.60 vs. 2.68±0.78, P <0.001;ODI 19.05±6.27 vs. 27.18±8.09, P =0.001). There was no significant difference in VAS score in the 2 weeks after surgery between group A and group B (2.32±0.48 vs. 2.55±0.67, P >0.05) whereas the ODI score in group A was lower than that of group B (21.79±4.70 vs. 25.73±6.30, P =0.043). There was significant difference in VAS score in the 3 months after surgery between group A and group B(2.00±0.58 vs. 2.59±0.67, P =0.007)there was no significant difference in ODI score after 3 months of surgery(22.53± 4.75 vs. 25.45±6.50, P > 0.05). Conclusion For vertebral compression fracture patients with distant pain, intraoperative paravertebral block and erector spinae local anesthesia is do not increase the operation time and risks and they effectively alleviate the distant pain in early stage after surgery that it is worthy of clinical promotion.