| 胡均立,崔豫宝,曾勇超,等.超声引导下脊神经背内侧支阻滞术联合PKP治疗老年OVCF的临床应用研究.骨科,2025,16(6): 500-504. |
| 超声引导下脊神经背内侧支阻滞术联合PKP治疗老年OVCF的临床应用研究 |
| Clinical application of ultrasound-guided medial branch block combined with percutaneous kyphoplasty in the treatment of elderly patients with osteoporotic vertebral compression fractures |
| 投稿时间：2025-07-26 |
| DOI：10.3969/j.issn.1674-8573.2025.06.004 |
| 中文关键词: 超声引导 脊神经背内侧支阻滞 经皮椎体后凸成形术 骨质疏松 椎体压缩骨折 疼痛管理 老年 |
| 英文关键词: Ultrasound guidance Medial branch block Percutaneous kyphoplasty Osteoporosis Vertebral compression fracture Pain management Elderly |
| 基金项目:孝感市自然科学计划项目（XGKJ2022010043） |
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| 中文摘要: |
| 目的 探讨超声引导下脊神经背内侧支阻滞（medial branch block，MBB）联合经皮椎体后凸成形术（PKP）治疗老年胸腰椎骨质疏松性椎体压缩骨折（OVCF）的疗效，评估其对围术期疼痛控制、手术安全性、功能恢复及生存质量的影响。方法 将2022年6月至2023年6月收治的80例胸腰椎OVCF病人根据实际手术方式分为观察组（超声引导下MBB+PKP，40例）和对照组（单纯PKP，40例）。观察组在PKP前行超声引导下目标及相邻节段双侧MBB（0.5%罗哌卡因）。观察两组术后第1天、第3天、第1个月的疼痛视觉模拟量表（VAS）评分、日本骨科协会（JOA）评分、住院时间、静脉自控镇痛（PCIA）按压次数、追加镇痛次数及不良反应。结果 观察组术后第1、3天的VAS评分均较对照组更低[（2.95±0.75）分 vs. （3.85±0.58）分，（1.95±0.39）分 vs. （2.17±0.38）分]，JOA评分明显高于对照组[（18.15±2.86）分 vs. （15.95±1.72）分，（20.98±2.67）分 vs. （19.48±1.63）分]，差异有统计学意义（P＜0.05），但两组术后第1个月的VAS评分、JOA评分差异无统计学意义（P＞0.05）。观察组PCIA按压次数及追加镇痛次数均显著少于对照组（P＜0.05）。两组住院时间及不良反应发生率比较，差异无统计学意义（P＞0.05）。结论 超声引导下MBB联合PKP可显著优化老年OVCF病人围术期镇痛效果，促进早期功能康复，降低镇痛需求，是一种安全高效的综合治疗模式。 |
| 英文摘要: |
| Objective To explore the efficacy of ultrasound (US)-guided medial branch block (MBB) combined with percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fractures (OVCF) in the elderly, and to evaluate its impact on perioperative pain control, surgical safety, functional recovery, and quality of life. Methods A total of 80 patients with thoracolumbar fractures admitted from June 2022 to June 2023 were divided into the observation group (US-guided MBB+PKP, 40 cases) and the control group (PKP alone, 40 cases) according to the surgical methods. In the observation group, bilateral MBB (0.5% ropivacaine) was performed under US guidance at the target and adjacent segments before PKP. The visual analogue scale (VAS) scores and Japanese Orthopaedic Association (JOA) scores of the two groups on the 1st day, the 3rd day and the first month after surgery, hospital stay, the number of patient-controlled intravenous analgesia (PCIA) presses, the number of additional analgesia and adverse reactions were observed. Results The VAS scores of the observation group on the 1st and 3rd day after surgery were significantly lower than those of the control group (2.95±0.75 vs. 3.85±0.58, 1.95±0.39 vs. 2.17±0.38, P＜0.05), but there was no significant difference on the first month after surgery (P＞0.05). The JOA scores of the observation group on the 1st and 3rd day after surgery were significantly higher than those of the control group (18.15±2.86 vs. 15.95±1.72, 20.98±2.67 vs. 19.48±1.63, P＜0.05), but there was no significant difference on the first month after surgery (P＞0.05). The number of PCIA presses and additional analgesia times in the observation group were significantly less than those in the control group (P＜0.05). There was no significant difference in hospital stay and the incidence of adverse reactions between the two groups (P＞0.05). Conclusion US-guided MBB combined with PKP significantly optimizes perioperative analgesia, promotes early functional recovery, reduces analgesic requirements in elderly OVCF patients, representing a safe and effective comprehensive treatment approach. |
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