术区局部镇痛在经皮椎弓根钉治疗胸腰椎骨折中的自身对照研究

摘要

目的 探讨术区局部麻醉镇痛在经皮椎弓根螺钉内固定系统治疗胸腰椎骨折中的临床效果.方法 采用自身对照的方法前瞻性研究我科2014年1月至2016年3月收治的胸腰椎骨折行经皮椎弓根螺钉复位内固定的患者35例.每位患者将左侧两切口和右侧两切口随机分为罗哌卡因联合肾上腺素配方的局麻药物注射侧(A组)和对照侧(B组).记录麻醉清醒后3、6、12、24、48h、术后1年单侧腰痛VAS评分,术前和术后1年的ODI评分,观察术后并发症和切口愈合情况.结果 局麻药物注射组术后3、6、12、24h VAS评分低于对照组(P＜0.05);术后48h、1年VAS评分两组间无显著统计学差异(P＞0.05).术后1年的ODI评分较术前显著性降低(P＜0.05).所有患者均未出现明显的全身或局部并发症.结论 脊柱后路手术术区罗哌卡因联合肾上腺素局麻镇痛可缓解术后早期疼痛,是一种操作简单、安全有效的早期镇痛方法.%Objective To investigate the clinical effects of local analgesia in treatment of thoracolumbar fractures with percutaneous pedicle screw fixation.Methods Using self-control prospective method,35 patients with thoracolumbar fractures who underwent percutaneous pedicle screw fixation in our department from Jan 2014 to Mar 2016 were enrolled in this study.For every patient,the right incision and left incision were randomly divided into group A (local analgesia with combination of ropivacaine and epinephrine),and group B (control group).The VAS of unilateral back pain after surgery (3,6,12,24,48 h,1 year),preoperative and 1 year postoperative ODI,postoperative complications and incisions were recorded.Results VAS score in local analgesia group were lower than those in control group at 3,6,12,24 h (P＜0.05);there were no significant differences in 48 h and 1 year VAS score between the 2 groups (P＞0.05).1 year postoperative ODI were lower than preoperative ODI (P＜0.05).No serious postoperative complication was found in these patients.Conclusion Local analgesia with combination ofropivacaine and epinephrine in posterior spinal surgery can effectively reduce early pain after operation,which is a simple,safe and effective early analgesia method.