Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, NO. 25 Taiping Street, Luzhou City, 646000, Sichuan, China.
BMC Musculoskelet Disord. 2020 Nov 12;21(1):743. doi: 10.1186/s12891-020-03778-1.
Surgeons recognize that using percutaneous kyphoplasty (PKP) under local anesthesia to treat osteoporotic vertebral fracture (OVF) prevents interference with the general situation of elderly patients suffering from multiple organ dysfunction. Surgeons can directly assess whether nerve injury occurs while the patient is awake. However, when patients with multiple osteoporotic vertebral fractures (m-OVFs) receive local anesthesia, fluoroscopy time often has to be increased, the operative time has to be extended, or the operation has to be terminated because of discomfort related to body posture. No relevant study has thus far been conducted on the type of anesthesia to administer to patients undergoing PKP for m-OVFs. This study aimed to determine which of the two types of anesthesia is more suitable for PKP for m-OVFs.
A retrospective study was conducted involving 159 patients who underwent PKP for m-OVFs from January 2016 to January 2020; 81 patients underwent PKP under general anesthesia (Group G), and 78 patients underwent PKP under local anesthesia (Group L). Clinical and adverse events were compared between the two groups.
The intraoperative mean arterial pressure, average heart rate, average fluoroscopy times of each vertebral body, and operative time were less in Group G than in Group L. The visual analog scale (VAS) score was significantly lower after than before the operation. The anterior vertebral height (AVH), middle vertebral height (MVH), and kyphotic angle (KA) were significantly improved in both groups postoperatively. The improvement in VAS score, AVH, MVH, and KA in Group G were higher than those in Group L. No significant difference in the incidence of complications was observed between the two groups.
PKP under either general anesthesia or local anesthesia was reliable. Compared with PKP under local anesthesia, PKP under general anesthesia could more reliably maintain the stability of vital signs, alleviate preoperative pain in patients, and attain a better orthopedic effect. Moreover, the latter does not increase the complications of patients with m-OVFs. However, the high medical expense of PKP under general anesthesia is a factor to consider when choosing the type of anesthesia.
外科医生认识到，在局部麻醉下使用经皮椎体后凸成形术（PKP）治疗骨质疏松性椎体骨折（OVF）可以防止干扰患有多器官功能障碍的老年患者的一般情况。外科医生可以在患者清醒时直接评估是否发生神经损伤。然而，当患有多处骨质疏松性椎体骨折（m-OVFs）的患者接受局部麻醉时，透视时间往往不得不延长，手术时间不得不延长，或者不得不因为与体位相关的不适而终止手术。因此，目前还没有关于为接受 m-OVFs 的 PKP 患者使用哪种麻醉类型的相关研究。本研究旨在确定两种麻醉类型中哪一种更适合 m-OVFs 的 PKP。
回顾性研究了 2016 年 1 月至 2020 年 1 月期间接受 m-OVFs 的 PKP 的 159 例患者；81 例患者接受全身麻醉下的 PKP（G 组），78 例患者接受局部麻醉下的 PKP（L 组）。比较两组患者的临床及不良事件。
G 组患者术中平均动脉压、平均心率、每个椎体的平均透视时间和手术时间均低于 L 组。与术前相比，术后视觉模拟量表（VAS）评分明显降低。两组患者术后前椎体高度（AVH）、中椎体高度（MVH）和后凸角（KA）均明显改善。G 组患者 VAS 评分、AVH、MVH 和 KA 的改善程度均高于 L 组。两组患者并发症发生率无统计学差异。
PKP 在全身麻醉或局部麻醉下均可靠。与局部麻醉下的 PKP 相比，全身麻醉下的 PKP 更能可靠地维持生命体征的稳定，减轻患者术前疼痛，达到更好的矫形效果。此外，后者不会增加 m-OVFs 患者的并发症。然而，全身麻醉下 PKP 的高昂医疗费用是选择麻醉类型时需要考虑的一个因素。
