胸腰筋膜阻滞联合椎体成形治疗骨质疏松性椎体骨折的疗效观察

Clinical efficacy of ultrasound-guided thoracolumbar interfascial plane block combined with percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures

摘要:

目的 研究超声引导下胸腰筋膜平面阻滞（thoracolumbar interfascial plane block,TLIPB）联合椎体成形术（percutaneous vertebroplasty ,PVP）治疗骨质疏松性椎体压缩性骨折（osteoporotic vertebral compression fractures ,OVCF）的临床疗效。方法 选取2024年1月至2025年6月临沧市人民医院收治的60例OVCF老年患者，采用随机数字表法将其分为三组（每组20例）：局部麻醉下实施椎体成形术并联合超声引导下双侧胸腰筋膜平面阻滞（TLIPB+PVP组），超声引导下双侧胸腰筋膜平面阻滞（TLIPB组），椎体成形术（PVP组）。三组患者术后均按需使用同一种镇痛药物进行补救镇痛治疗。观察并比较三组患者在术前、术后6 h、12 h、24 h、48 h的视觉模拟评分（VAS）、术前与术后48 h的功能障碍指数（ODI）评分、术后48 h内补救镇痛次数、镇痛药物不良反应（恶心、呕吐、局麻药中毒）发生率，以及术后是否需加做PVP或TLIPB等多项指标。结果 术后6 h和12 h的VAS评分中，TLIPB+PVP组显著低于PVP组，PVP组显著低于TLIPB组（p＜0.05）；术后24 h和48 h的VAS评分中，TLIPB+PVP组与PVP组均显著低于TLIPB组（p＜0.05）；术后48 h的ODI评分中，TLIPB组显著高于PVP组，PVP组显著高于TLIPB+PVP组（p＜0.05）；术后48 h内补救镇痛次数方面，TLIPB组显著高于PVP组和TLIPB+PVP组；镇痛药物不良反应发生率中，TLIPB+PVP组显著低于PVP组，PVP组显著低于TLIPB组（p＜0.05）。TLIPB组术后加做PVP与PVP组术后加做TLIPB的差异无统计学意义（p＞0.05）。结论 超声引导下胸腰筋膜平面阻滞（TLIPB）联合椎体成形术（PVP）治疗老年患者骨质疏松性椎体压缩性骨折（OVCF），可显著缓解术后早期腰痛，提高患者生活质量，减少术后镇痛药物使用频次，降低镇痛药物不良反应发生率和二次补手术率，具有较高的临床推广价值。

Abstract:

Objective To observe the clinical efficacy of ultrasound-guided TLIPB combined with PVP in the treatment of OVCF in elderly patients.Methods Sixty elderly patients with OVCF admitted to Lincang People's Hospital from January 2024 to June 2025 were randomly divided into three groups (20 cases in each group) using a random number table method: local anesthesia with vertebral augmentation surgery combined with ultrasound-guided bilateral thoracolumbar fascia plane block (TLIPB+PVP group), ultrasound-guided bilateral thoracolumbar fascia plane block (TLIPB group), and vertebral augmentation surgery (PVP group). All three groups of patients were treated with the same analgesic medication as needed for salvage analgesia after surgery. Observe and compare the visual analog scale (VAS) scores, functional impairment index (ODI) scores, number of rescue analgesia attempts within 48 hours after surgery, incidence of adverse drug reactions (nausea, vomiting, local anesthetic poisoning), and whether PVP or TLIPB should be added after surgery among three groups of patients before surgery, 6 hours, 12 hours, 24 hours, and 48 hours after surgery.Results Comparative analysis among the three groups revealed that VAS scores were significantly lower in the TLIPB+PVP group than in the PVP group at 6 and 12 hours postoperatively, and significantly lower in the PVP group than in the TLIPB group(p<0.05); The VAS scores of TLIPB+PVP group and PVP group were significantly lower than those of TLIPB group at 24 hours and 48 hours after surgery(p<0.05); The ODI functional impairment score 48 hours after surgery was significantly higher in the TLIPB group than in the PVP group, and significantly higher in the PVP group than in the TLIPB+PVP group; In terms of the frequency of rescue analgesia within 48 hours after surgery, the TLIPB group was significantly higher than the PVP group and the TLIPB+PVP group; The adverse reaction rate of analgesic drugs in the TLIPB+PVP group was significantly lower than that in the PVP group, and the PVP group was significantly lower than the TLIPB group (p<0.05). There was no significant difference (p>0.05) between the TLIPB group who underwent PVP again after surgery and the PVP group who underwent TLIPB again after surgery.Conclusion Ultrasound guided TLIPB combined with PVP for the treatment of OVCF in elderly patients can significantly alleviate early postoperative lumbar pain, improve quality of life, reduce the frequency of postoperative analgesic drug use, reduce the incidence of adverse reactions to analgesic drugs and the rate of secondary surgeries,，and is worthy of clinical promotion.