蔡俊,王永祥,冯新民,杨建东,陶玉平,张亮,张志强
CAI Jun,WANG Yong-xiang,FENG Xin-min,YANG Jian-dong,TAO Yu-ping,ZHANG Liang,ZHANG Zhi-qiang

• 1:江苏省苏北人民医院骨科

摘要(Abstract)：

目的探讨椎体成形术采用椎体松质骨浸润麻醉对术中骨性疼痛的缓解作用。方法 162例骨质疏松性椎体骨折患者,随机分为局麻组73例和椎体浸润组89例,局麻组采用常规局部麻醉,椎体浸润组采用椎体内浸润麻醉。2组患者于术前、术中穿刺时、注射骨水泥时及术后1d行疼痛视觉模拟评分(visual analogue score,VAS)评价镇痛效果;松质骨内注射利多卡因5、10、20、30min采用酶联免疫测定技术检测血清利多卡因浓度,评估麻醉安全性;2组于术前和术后6个月行Oswestry功能障碍指数(Oswestry disability index,ODI)评分评价手术效果。结果术中穿刺时和注射骨水泥时局麻组患者VAS评分(6.1±1.7、4.0±1.9)明显高于椎体浸润组(3.0±1.9、2.4±1.4)(P<0.05),术前和术后1d时局麻组患者VAS评分(7.2±1.5、1.6±0.9)与椎体浸润组(7.1±1.6、1.7±1.0)比较差异无统计学意义(P>0.05);术中10、20min时局麻组血清利多卡因水平[(1.50±0.13)、(0.60±0.08)ng/L]低于椎体浸润组[(2.70±0.20)、(1.30±0.10)ng/L](P<0.05),术中5、30min时,局麻组血清利多卡因水平[(1.20±0.11)、(0.26±0.07)ng/L]与椎体浸润组[(1.10±0.10)、(0.40±0.08)ng/L]比较差异无统计学意义(P>0.05);术前和术后6个月局麻组患者ODI评分(83.9±7.6、23.8±9.2)与椎体浸润组(85.3±8.5、21.7±9.8)比较差异均无统计学意义(P>0.05),术后6个月2组患者ODI评分均明显低于术前(P<0.05)。结论与传统局部麻醉比较,椎体松质骨浸润麻醉在椎体成形术中能明显缓解患者术中疼痛。
Objective To investigate the effect of infiltration anesthesia within vertebral cancellous bone on relieving bone pain during vertebroplasty.Methods Totally 162 cases of vertebral osteoporotic fractures were randomly divided into conventional local anesthesia group(n=73)and vertebral infiltration anesthesia group(n=89).The analgesia effects were evaluated before operation,during puncture,during injecting bone cement and 1 day after operation by means of visual analogue score(VAS)in two groups.The safety of intravertebral anesthesia was assessed by detecting plasma lidocaine levels by ELISA technique in 5,10,20 and 30 min after injecting lidocaine into cancellous bone.The result of operation was evaluated by Oswestry dysfunction index(ODI)in two groups before and in 6 months after operation.Results During puncture and injecting bone cement,VAS scores were significantly higher in conventional local anesthesia group(6.1±1.7,4.0±1.9)than those in vertebral infiltration anesthesia group(3.0±1.9,2.4±1.4)(P<0.05),and there were no significant differences in the VAS scores before and 1 day after operation between conventional local anesthesia group(7.2±1.5,1.6±0.9)and vertebral infiltration anesthesia group(7.1±1.6,1.7±1.0)(P>0.05).In10 and 20 min after injecting lidocaine,the serum concentrations of lidocaine were significantly lower in conventional local anesthesia group((1.5±0.13),(0.60±0.08)ng/L)than those in vertebral infiltration anesthesia group((2.70±0.20),(1.30±0.10)ng/L)(P<0.05),and there were no significant differences in the serum concentrations of lidocaine in 5 and 30 min between conventional local anesthesia group((1.20±0.11),(0.26±0.07)ng/L)and vertebral infiltration anesthesia group((1.10±0.10),(0.40±0.08)ng/L)(P>0.05).The ODI scores showed no significant differences between conventional local anesthesia group(83.9±7.6,23.8±9.2)and vertebral infiltration anesthesia group(85.3±8.5,21.7±9.8)before operation and in 6 months after operation(P>0.05),and the ODI scores were significantly lower in 6 months after operation than those before operation in both groups(P<0.05).Conclusion Infiltration anesthesia within vertebral cancellous bone can more effectively relieve the pain during vertebroplasty in comparison with conventional local anesthesia.

关键词(KeyWords)： 椎体压缩性骨折;浸润麻醉;经皮椎体成形
Vertebral compression fractures;infiltration anesthesia;percutaneous vertebroplasty

Abstract:

Keywords:

基金项目(Foundation): 江苏省自然科学基金(BK20141281);; 江苏省社会发展基金(be2013911);; 江苏省六大人才高峰项目(wsw-133)

作者(Author): 蔡俊,王永祥,冯新民,杨建东,陶玉平,张亮,张志强
CAI Jun,WANG Yong-xiang,FENG Xin-min,YANG Jian-dong,TAO Yu-ping,ZHANG Liang,ZHANG Zhi-qiang

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