超声引导下竖脊肌平面阻滞在椎体后凸成形术中的应用研究

Application of ultrasound-guided erector spinae muscle block in percutaneous kyphoplasty

目的探讨超声引导下竖脊肌平面阻滞在椎体后凸成形术中的安全性及有效性。方法择期行椎体后凸成形术患者60例,随机分为两组:超声引导下竖脊肌平面阻滞组(S组)和局部浸润麻醉组(L组),每组30例。比较两组患者在手术切皮时(T1)、穿刺针穿刺定位椎弓根时(T2)、球囊置入并行加压扩张操作时(T3)时的疼痛视觉模拟量表评分(VAS)、术后1 d和术后3个月Oswestry功能障碍指数评分(ODI),以及手术时间、对麻醉的满意度、不良事件、下肢运动神经阻滞情况。结果两组患者在T1时VAS评分比较,差异无统计学意义(t=1.14,P>0.05)。S组患者在T2和T3时VAS评分均低于L组,差异均有统计学意义(t分别=3.03、2.80,P均<0.05)。S组患者术后1天ODI评分低于L组(t=16.10,P<0.05),但两组在术后3个月ODI评分比较,差异无统计学意义(t=0.81,P>0.05)。S组的手术用时与L组比较,差异无统计学意义(t=0.88,P>0.05)。S组患者对麻醉总满意高于L组(χ^2=8.15,P<0.05)。随访期间,两组均未出现穿刺部位血肿、神经损伤等不良事件和下肢运动神经阻滞。结论与局麻浸润麻醉相比,超声引导下竖脊肌平面阻滞应用在椎体后凸成形术中能减少患者的疼痛,提高患者满意度,安全性较高。

Objective To investigate the safety and effectiveness of ultrasound-guided erector spinae muscle plane block in kyphoplasty surgery.Methods Sixty patients undergoing percutaneous kyphoplasty surgery were randomly di⁃vided into ultrasound-guided erector spinae muscle plane block group(group S)and local infiltration anesthesia group(group L),30 cases in each.The visual analogue scale(VAS)at surgical skin incision(T1),puncture needle puncture to locate the pedicle(T2),and balloon placement and compression expansion operation(T3),Oswestry dysfunction index(ODI)scores at 1 day and 3 months after operation,operation time,satisfaction with anesthesia,adverse events,and low⁃er limb motor nerve block between two groups were compared.Results There was no significant difference in VAS scores between the two groups at T1(t=1.14,P>0.05).The VAS scores at T2 and T3 of group S were lower than those of group L(t=3.03,2.80,P<0.05).The ODI score of the S group was lower than that of the L group at 1 day after operation(t=16.10,P<0.05),but there was no significant difference in the ODI score between two groups at 3 months after oper⁃ation(t=0.81,P>0.05).There was no significant difference in the operation time between group S and group L(t=0.88,P>0.05).The total satisfaction rate in group S was higher than that in group L(χ^2=8.15,P<0.05).During the followup,there was no adverse events such as hematoma at the puncture site,nerve injury,and motor nerve block of the lower limbs occurred in two groups.Conclusion Comparing to local infiltration,ultrasound-guided erector spinae plane block in kyphoplasty can reduce pain during surgery,improve patient satisfaction.