Comparative efficacy of percutaneous vertebroplasty under enhanced regional and conventional anesthesia for multisegmental acute symptomatic osteoporotic thoracolumbar fractures
10.3760/cma.j.cn501098-20240226-00164
- VernacularTitle:局部强化与常规麻醉下经皮椎体成形术治疗多节段急性症状性骨质疏松性胸腰椎骨折的疗效比较
- Author:
Jialang ZHANG
1
;
Qingda LI
;
Yuan HE
;
Lingbo KONG
;
Junsong YANG
;
Lei ZHU
;
Jianan ZHANG
;
Xin CHAI
;
Shuai LI
;
Dingjun HAO
;
Baorong HE
Author Information
1. 陕西中医药大学第一临床医学院，咸阳 712046
- Keywords:
Osteoporosis;
Spinal fractures;
Aged;
Anesthesia;
Vertebroplasty
- From:
Chinese Journal of Trauma
2024;40(5):432-439
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the efficacy of percutaneous vertebroplasty (PVP) under enhanced regional and conventional anesthesia for multisegmental acute symptomatic osteoporotic thoracolumbar fractures (m-ASOTLF).Methods:A retrospective cohort study was conducted to analyze the data of 91 patients with m-ASOTLF who were admitted to Honghui Hospital of Xi′an Jiaotong University from January 2021 to December 2022, including 36 males and 55 females, aged 55-80 years [(67.4±7.3)years]. According to American Society of Anesthesiologists (ASA) classification system, 18 patients were classified as grade I, 52 grade II, and 21 grade III. Injured segments included T 6-T 10 in 23 patients, T 11-L 2 in 47 and L 3-L 5 in 21. All the patients were treated with PVP, among whom 45 were given enhanced regional anesthesia (enhanced anesthesia group) and 46 regional conventional anesthesia (conventional anesthesia group). The following indicators were compared between the two groups: the operation time, intraoperative bleeding, intraoperative heart rate, intraoperative mean arterial pressure (MAP), number of intraoperative fluoroscopies, and total amount of bone cement injected; the visual analogue scale (VAS) and Oswestry dysfunction index (ODI) before surgery, at 1 day, 1 month after surgery and at the last follow-up; the mini-mental state examination (MMSE) before surgery, at 1, 6, and 12 hours after surgery; the anterior vertebrae height (AVH), middle vertebrae height (MVH), and vertebral kyphosis angle (VKA) before and at 1 day after surgery; the incidence of complications such as bone cement leakage. Results:All the patients were followed up for 12-20 months [(15.8±2.6)months]. There were no significant differences between the two groups in the operation time, intraoperative bleeding, intraoperative heart rate, intraoperative MAP, number of intraoperative fluoroscopies or total amount of bone cement injected ( P>0.05). No significant differences were found between the two groups in VAS or ODI before surgery and at the last follow-up ( P>0.05). The VAS scores in the enhanced anesthesia group were (2.5±0.4)points and (1.8±0.3)points at 1 day and 1 month postoperatively respectively, which were both lower than (3.5±0.4)points and (2.0±0.5)points in the conventional anesthesia group ( P<0.01). The ODI values in the enhanced anesthesia group were 39.8±3.3 and 26.5±5.0 at 1 day and 1 month postoperatively respectively, which were both lower than 43.8±7.5 and 30.3±6.4 in the conventional anesthesia group ( P<0.01). The VAS and ODI at all postoperative time points decreased in both groups compared with those before surgery, with significant differences among those at all postoperative time points ( P<0.05). There was no significant difference between the two groups in the MMSE scores before, at 1, 6, and 12 hours after surgery ( P>0.05). The MMSE scores at 1 and 6 hours postoperatively were lower than that preoperatively in both groups ( P<0.05), and it was increased at 6 hours compared with that at 1 hour postoperatively ( P<0.05). There was no significant difference between the MMSE scores at 12 hours postoperatively and preoperatively in both groups ( P>0.05). The differences between the two groups in AVH, MVH, or VKA preoperatively were not statistically significant ( P>0.05). The AVH and MVH at 1 day postoperatively in the enhanced anesthesia group were (22.4±4.2)mm and (22.7±3.7)mm respectively, which were both higher than those in the conventional anesthesia group [(19.3±3.7)mm and (20.1±6.3)mm] ( P<0.05 or 0.01); the VKA at 1 day postoperatively in the enhanced anesthesia group was (13.9±3.7)°, which was lower than that in the conventional anesthesia group (15.8±4.1)° ( P<0.05). The AVH, MVH, and VKA in both groups were all improved at 1 day postoperatively compared with those preoperatively ( P<0.05). The incidence of bone cement leakage in the enhanced anesthesia group was 6.7% (3/45), which was lower than 21.7% (10/46) in the conventional anesthesia group ( P<0.05). Conclusion:Compared with conventional regional anesthesia, PVP under enhanced regional anesthesia for m-ASOTLF has more advantages in early postoperative pain relief, improvement of spinal function, restoration of vertebral height and reduction of bone cement leakage.
