| Objective:To explore and compare the efficacy and clinical application value of intravertebral injection of lidocaine in vertebroplasty for elderly thoracolumbar compression fractures.Method:Patients with thoracic and lumbar vertebrae single-segment compression fractures diagnosed by simple elderly osteoporosis were collected from November 2017 to April 2019 at the 967 th Hospital of the Joint Logistics Support Unit of the PLA,formerly 210 Hospital,A total of 183 subjects were screened strictly based on diagnostic criteria,inclusion criteria,and exclusion criteria.Prior to this,through animal spine vertebral body experiments,we initially reached the following conclusions,In vitro experiments on adult pigs with osteoporotic vertebral compression fractures of the lower thoracic vertebrae and lumbar vertebrae have shown that balloon compression can effectively restore the vertebral body compression height,The unilateral vertebral body is injected with a 1.5-ml lidocaine local anesthetic through the self-contained channel of the balloon cannula.See the text for the purpose,process and conclusion of animal experiment.The above experimental results provide an important reference value for the control of pressure during balloon expansion during clinical practice and the amount of local anesthetic lidocaine injected into the affected vertebrae.Therefore,183 subjects were randomly divided into 3 groups,among them,there were 31 cases in control group A,without injection in the affected vertebra.Control group B,intravertebral injection of the same amount of normal saline,because of the different injection dose in each subgroup of group C,we took 1.5ml saline injection,a total of 35 cases.A total of 117 patients in experimental group C,injected with lidocaine.There were 23 cases in group C1,inject 2% lidocaine into the vertebral body through bilateral channels,each with 0.5ml.A total of 21 cases in the C2 group,inject 2ml lidocaine into the vertebral body through bilateral channels,each with 1ml.A total of 27 cases in the C3 group,inject 2mllidocaine into the vertebral body through bilateral channels,1.5ml each.A total of 25 cases in the C4 group,inject 2% lidocaine into the vertebral body through bilateral channels,each 2.0ml.A total of 21 cases in the C5 group,inject 2ml lidocaine into the vertebral body through bilateral channels,each 2.5ml.Visual analog scores were compared between the three groups A,B,and C,and between the five groups C1,C2,C3,C4,and C5 before surgery,when the balloon was unfolded,when bone cement was injected into the vertebrae,and after 24 hours.analogue scale VAS to assess pain,postoperative hospital stay(days),age(age),and bone cement injection volume(ml).Statistical analysis of the obtained data,to explore and compare the analgesic effect,influencing factors and clinical application value of intravertebral injection of lidocaine in vertebroplasty for elderly thoracolumbar compression fractures.At the same time,the optimal dose of lidocaine injected into the vertebra during the operation was obtained.Results:1.All the above research subjects strictly complied with the standards of surgery and experiments and obtained the consent of the hospital ethics committee,at the same time,signed informed consent with the patients,and completed it safely.In 7 cases,a small amount of bone cement leaked to the sides of the vertebral body,in front of the vertebral body,and near and below the intervertebral disc.But no adverse symptoms such as nerve compression or stimulation occurred.2.Most patients in groups A and B experienced painful irritations such as restlessness,shouting,and sweating during intraoperative expansion of bilateral balloons and injection of bone cement into vertebra.At the same time,the patient's heart rate and breathing rate increased as well as blood pressure fluctuated greatly before and after,due to painful stimuli,and even speech comfort did not improve significantly.Compared with the groups A and B,Patients in group C(C1,C2,C3,C4,C5)had less painful stimulation during the entire operation,relatively stable emotions and vital signs,and effective verbal comfort.However,In group C,there were 3 cases of lidocaine complications in the C4 and C5 groups with a dose exceeding 3ml: 1 case had sudden tinnitus and returned to normal after about 5 minutes,2 cases had mild dizziness,clear consciousness,and symptoms disappeared after a few minutes.3.According to the analysis of the data obtained in Table(1),the VAS pain scores of the two groups of patients A and B were no significant difference,(P > 0.05)no statistical significance,during the intraoperative balloon distraction,the intravertebral injection of bone cement,and at the end of the operation,and within 24 hours after the operation.At the same time,there was no significant difference in the data of A,B groups in terms of age,gender,length of hospital stay,operation time,and amount of bone cement injection(P> 0.05).4.The data in Table(2)is a combination of the data of two groups A and B,a total of 66 cases without lidocaine injection,and the first three subgroups(C1,C2,C3)of group C,71 cases with lidocaine injection,Compared.Because according to the data in Table(1),there was no significant difference(P> 0.05)in the data between the two groups of patients A,B before surgery,during balloon expansion,during bone cement injection,and after surgery.Therefore,the data of the two groups A and B are combined with the first three subgroups(C1,C2,C3)of the C group to compare(because the first three groups of lidocaine injection doses are less convincing than the last three groups),For the purpose is to further compare whether intraoperative injection of lidocaine and non-injection of lidocaine during the operation of the balloon have an effect on patients' pain during the operation.At the same time,the difference in the number of data between the group injected with lidocaine and the group not injected with lidocaine was balanced to achieve equilibrium between the groups,making them comparable.According to the analysis of the data obtained in Table(2),the patients without lidocaine injection(group A + B)and the patients with lidocaine injection C(C1+ C2 + C3)had a VAS pain score before surgery and a 24-hour VAS score after surgery.,Gender,age,operation time,amount of bone cement injected,length of hospital stay,etc.(P> 0.05)were not statistically significant.In the non-injected lidocaine group(group A + B),the intraoperative sacral balloon expansion,intraoperative vertebral injection of bone cement,and postoperative scoring were 8.969±0.0.60,9.393 ± 0.52,4.772 ± 0.67,respectively.However,Patients in the lidocaine injection group C(C1 + C2 + C3)scored 4.253 ±1.91,4.126 ±1.87,and 2.380±0.99 when the balloon was opened during the operation,when the bone cement was injected into the vertebra,and when the operation was completed.It can be seen that the difference in data between the two groups of patients receiving the lidocaine injection group and the non-injecting lidocaine group is statistically significant(P <0.05).5.The analgesic effect,compared with VAS score,in group C evaluated C1 <C2 <C3,C4,C5.There were no significant differences between the three groups of C3,C4,and C5.According to the analysis of the data obtained in Tables(3),(4),(5)and(6),the five subgroups C1,C2,C3,C4,and C5 in group C had VAS scores before surgery,at 24 hours after surgery,gender,age and operation time,bone cement injection volume,There was no significant difference in data such as length of stay(P> 0.05).According to the data analysis in Table(3),the VAS pain scores of the C1 and C2 groups during balloon expansion,bone cement injection,and postoperative surgery were6.608±0.49,6.304±0.47,3.391±0.49,and 4.285±0.46,4.428±0.50,2.523 ± 0.51,the difference in score between the two groups(P< 0.05)was statistically significant.According to the analysis of the data obtained in Table(4),the VAS pain scores of the two groups of C2 and C3 at the time of balloon expansion,bone cement injection and postoperative surgery were 4.285±0.46,4.428±0.50,2.523±0.51,2.222 ±0.50,2.037±0.51,1.407±0.57,the difference in score between the two groups(P<0.05)was statistically significant.According to the analysis of the data obtained in Table(5),at the time of balloon expansion,bone cement injection,and completion of the operation,the VAS pain scores of the C3 and C4 groups were 2.222 ± 0.50,2.037 ± 0.51,1.407 ± 0.57,and2.200 ± 0.57,2.000 ± 0.51,1.240 ± 0.52,there was no significant difference in scores between the two groups(P> 0.05).According to the analysis of the data obtained in Table(6),the VAS pain scores of the C4 and C5 groups were 2.200±0.57,2.000±0.51,1.240±0.52,and 2.047±0.49,1.714±0.46,1.190±0.51 at the time of balloon expansion,bone cement injection,and operation completion.there was no significant difference in scores between the two groups(P value> 0.05)Conclusion:1.Injecting 2% lidocaine,intraosseous anesthesia,into the vertebral body through the balloon's built-in channel during the surgery can significantly reduce the pain during the operation.Compared with the basic anesthesia and the injection of normal saline into the vertebral body,it has analgesia.It has clear and satisfactory results,rapid onset,low cost,low risks and complications,minimal impact on the whole body,and easy acceptance by patients.And hopefully completely replace basic anesthesia or general anesthesia.Moreover,the procedure under local anesthesia can be completely painless or slightly painful.2.The best and appropriate amount of 2% lidocaine injected into the vertebrae through the built-in channels of the balloons on both sides is1.5ml each,3ml in total.At this dose,the analgesic effect is close to or reaches the optimal level,lower than this dose,the analgesic effect is not good,and the analgesic effect beyond this dose is not significantly enhanced.And during this dose experiment,there were no adverse reactions such as lidocaine infusion to dizziness and tinnitus,which not only ensured the analgesic effect during the operation,but also ensured the patient's life safety. |
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