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目的比较透视下精准局部麻醉与全身麻醉经皮椎体后凸成形术(PKP)治疗老年骨质疏松性胸腰椎压缩骨折的疗效。方法观察组纳入自2014-06—2015-12采用透视下精准局部麻醉PKP治疗的40例骨质疏松性胸腰椎压缩骨折,对照组纳入同期采用全身麻醉PKP治疗的40例骨折。比较2组单个椎体手术时间、术中出血量、住院时间,术后1 d的VAS评分、椎体前缘高度、后凸角度,以及神经损伤发生率、骨水泥渗漏率。结果对照组术中神经损伤发生率高于观察组,差异有统计学意义(P<0.05);但2组骨水泥渗漏率差异无统计学意义(P>0.05)。2组单个椎体手术时间、术中出血量差异无统计学意义(P>0.05);观察组住院时间明显短于对照组,差异有统计学意义(P<0.05)。对照组术后1 d椎体前缘高度改善程度优于观察组,而观察组VAS评分优于对照组,差异有统计学意义(P<0.05)。结论透视下精准局部麻醉用于老年骨质疏松性胸腰椎压缩骨折PKP术中安全有效。
Objective To compare the effect of precise local anesthesia and general anesthesia percutaneous kyphoplasty (PKP) in the treatment of senile osteoporotic thoracolumbar vertebral compression fractures. Methods Forty osteoporotic thoracolumbar vertebral fractures treated with PKP under fluoroscopy under fluoroscopy were enrolled in the observation group. Forty fractures treated by PKP during the same period were enrolled in the control group. The operation time, intraoperative blood loss, length of hospital stay, VAS score at 1 day after operation, height of anterior vertebral body, kyphosis angle, incidence of nerve injury and bone cement leakage rate were compared between two groups. Results The incidence of intraoperative nerve injury in the control group was significantly higher than that in the observation group (P <0.05). However, there was no significant difference in the rate of bone cement leakage between the two groups (P> 0.05). There was no significant difference in the operation time and intraoperative blood loss between two groups (P> 0.05). The hospitalization time in the observation group was significantly shorter than that in the control group (P <0.05). The degree of improvement of the anterior vertebral height of the control group was better than that of the observation group on the 1st day after operation, while the VAS score of the observation group was superior to that of the control group (P <0.05). Conclusion Under the perspective of precision local anesthesia is safe and effective in the treatment of elderly osteoporotic thoracolumbar fractures.