中老年骨质疏松椎体骨折患者椎体成形术中疼痛评分与术后并发症的相关性研究

Study on the relationship between intraoperative pain and postoperative complications in mid-aged and elderly osteoporotic vertebral fracture patients treated with vertebroplasty

目的观察老年骨质疏松椎体骨折患者行椎体成形术中穿刺过程疼痛评分与术后并发症的相关性。方法回顾性病例对照研究,入选2010年1月到2020年12月北京医院骨科326例行椎体成形术治疗单节段骨质疏松椎体骨折患者的临床资料,对术后1个月内出现并发症(并发症组)患者42例(12.9%)与未出现并发症患者(无并发症组)284例(87.1%)进行比较。收集并发症组和无并发症组患者术前,术中软组织穿刺、骨性穿刺.骨水泥椎体注入和术后24 h,术后1个月和3个月的疼痛数字评价量表(NRS)评分变化,并进行组间比较。结果并发症组和无并发症组患者NRS评分术前(5.78±2.11)分比(6.10±2.21)分,术中软组织穿刺(7.59±1.46)分比(4.63±0.86)分,骨性穿刺(7.30±1.35)分比(5.14±1.07)分、骨水泥椎体注入(6.97±1.24)分比(6.11±1.58)分、术后24 h(4.09±0.82)分比(2.19±0.87)分、术后1个月(2.07±0.80)分比(1.93±0.78)分和术后3个月(1.83±0.72)分比(1.74±0.65)分,术前两组患者比较差异无统计学意义(P>0.05),并发症组术中软组织穿刺、骨性穿刺、骨水泥椎体注入、术后24 h评分高于无并发症组患者(均P<0.05)。并发症组和无并发症组患者组内比较,术前较术后24 h,术前较术后1个月,术后24 h较术后1个月差异有统计学意义(均P<0.05)。结论老年骨质疏松椎体骨折患者行局部麻醉下椎体成形术术后出现早期并发症患者在术中常出现剧烈疼痛,NRS评分增高。应重视避免或减少手术操作相关并发症,减轻老年患者术中疼痛,提高椎体成形术手术治疗效果。

Objective To examine the correlation between intraoperative pain scores duringpuncturing and postoperative complications in elderly patients with osteoporotic vertebral fractures(OVF)treated with vertebroplasty(VP).Methods In a retrospective case-control study,clinicaldata of 326 patients with single-segment OVF treated with VP,including 42 patients(12.9%)(thecomplication group)with complications within 1 month of surgery and 284 patients(87.1%)withoutcomplications(the control group),were compared.Changes in patient numerical evaluation scale(NRS)scores were recorded and compared for the complication group and the control group at different timepoints,which concluded preoperative(T0),intraoperative puncturing of soft tissues(T1),bonepuncturing(T2),bone cement injection into the vertebral body(T3),24 hours(T4),1 month(T5)and 3months(T6)after surgery.Results NRS scores for patients in the complication group vs.those inthe control group at different phase were(5.78±2.11 vs.6.10±2.21)points at To,(7.59±1.467 vs.4.63±0.86)points at T1,(7.30±1.35 vs.5.14±1.07)points at T2,(6.97±1.24 vs.6.11±1.58)points at T3,(4.09±0.82 vs.2.19±0.87)points at T4,(2.07±0.80 vs.1.93±0.78)points atT5,and(1.83±0.72 vs.1.74±0.65)points at T6,but there was no significant difference between thetwo groups at TO(P>0.05).The complication group had higher NRS scores than the control group at T1,T2,T3,and T4(all P<0.05).For intra-group comparisons,both the complication group and thecontrol group showed statistically significant differences between TO and T4,between T0 and T5,and between T4 and T5(all P<0.05).Conclusions Elderly OVF patients who are treated with VP andexhibit post-surgery complications often experienced severe pain during surgery,and an NRS scoregreater than 7 may be an independent risk factor for postoperative complications of VP.Effort shouldbe made to avoid or reduce complications related to surgery,reduce pain and improve treatmentoutcomes of VP for elderly patients.