Institute for Diagnostic Radiology and Neuroradiology, Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany.
AJNR Am J Neuroradiol. 2011 Apr;32(4):649-53. doi: 10.3174/ajnr.A2345. Epub 2011 Jan 27.
Kyphoplasty is a minimally invasive procedure for the treatment of malignant or osteoporotic vertebral compression fractures, normally performed with the patient under general anesthesia. This may cause a therapeutic dilemma because these patients often have a very high risk for general anesthesia due to concomitant diseases. The aim of this study was to evaluate the safety and feasibility of percutaneous kyphoplasty by using IV anesthesia and sedation with midazolam and piritramide.
From June 2007 to June 2009, we prospectively included 133 patients (77 women, 56 men; mean age, 69.18 ± 11.45 years) who were referred for BKP. Kyphoplasty was always performed under fluoroscopic guidance with a biplane angiographic system by using a transpedicular or extrapedicular approach. The individual anesthesia risk was assessed by using the ASA criteria. All procedures were performed with the patient under IV anesthesia and sedation with fractionated administration of midazolam and piritramide. Pain was assessed before and after treatment by using a VAS.
Ninety-nine patients (74.4%) had a significantly increased risk for general anesthesia (ASA score, ≥ 3). A total of 162 kyphoplasty procedures were performed. The mean amounts of midazolam and piritramide used were 11.3 ± 4.38 mg and 11.8 ± 3.98 mg, respectively. No complications related to IV anesthesia and sedation occurred. Periprocedural pain management was rated as sufficient, and all patients would undergo the procedure again.
Percutaneous BKP with the patient under IV anesthesia and sedation with midazolam and piritramide is a safe and feasible method for treating vertebral compression fractures in patients with an increased risk for general anesthesia.
椎体后凸成形术是一种治疗恶性或骨质疏松性椎体压缩性骨折的微创手术，通常在全身麻醉下进行。由于合并症，这些患者通常存在全麻的高风险，这可能导致治疗困境。本研究旨在评估使用 IV 麻醉和咪达唑仑与哌替啶镇静行经皮椎体后凸成形术的安全性和可行性。
自 2007 年 6 月至 2009 年 6 月，我们前瞻性纳入 133 例患者（77 例女性，56 例男性；平均年龄 69.18±11.45 岁），这些患者因 BKP 而被转诊。经皮椎体后凸成形术总是在透视引导下使用双平面血管造影系统通过经皮或经皮外途径进行。个体麻醉风险通过 ASA 标准进行评估。所有手术均在 IV 麻醉和镇静下进行，分次给予咪达唑仑和哌替啶。使用 VAS 在治疗前后评估疼痛。
99 例（74.4%）患者全麻风险显著增加（ASA 评分≥3）。共进行了 162 次椎体后凸成形术。咪达唑仑和哌替啶的平均用量分别为 11.3±4.38mg 和 11.8±3.98mg。未发生与 IV 麻醉和镇静相关的并发症。围手术期疼痛管理被评为充分，所有患者均会再次接受该手术。
在全身麻醉风险增加的患者中，使用 IV 麻醉和镇静下的经皮椎体后凸成形术是一种安全可行的治疗椎体压缩性骨折的方法。
