经皮椎体成形术后骨水泥渗漏的回顾性分析及预防策略

摘要

Objective To retrospectively analyze the incidence and prevention strategies of bone cement leakage in 152 patients, who had 187 thoracolumbar fractures and received percutaneous vertebroplasty (PVP or PKP). Methods A total of 152 patients, who had 187 thoracolumbar osteoporotic compression fractures and received PVP or PKP from May 2007 to May 2012, were enrolled. All patients received CT scanning postoperatively. Statistics showed that 65 vertebrae ( 34.76% ) had bone cement leakage , including 38 vertebrae (50.66%) after PVP and 27 vertebrae (24. 11%) after PKP. Fifteen vertebrae (8. 02% ) had bone cement leakage into the spinal canal , including 9 vertebrae after PVP and 6 after PKP. Twenty-three vertebrae (12. 30% ) had bone cement leakage to the vertebral margins ( front edges and side edges), including 12 after PVP and 11 after PKP. One vertebra (0.53%) after PVP had bone cement leakage into the pedicle tube. Thirteen vertebrae (6. 95% ) had bone cement leakage into the intervertebral space, including 7 after PVP and 6 after PKP. Eight vertebrae (4. 28% ) had bone cement leakage into the needle channel, including 4 after PVP and 4 after PKP. Five vertebrae (2. 67% ) after PVP had bone cement leakage into the intervertebral vein. The therapeutic effect was observed. The reasons leading to bone cement leakage and preventive measures were summarized . Results All patients had obvious pain relief after the operation. In patients with bone cement leakage , 1 patient with bone cement leakage into the pedicle tube had nerve compression symptoms , which was relieved by decompression. Other patients had no obvious nerve compression symptoms. Conclusions The incidence of bone cement leakage after PVP is pretty high (34. 76% ). And the most common leakage appears at the vertebral margins (35. 38% ). But few patients (1.53%) have clinical symptoms. Bone cement leakage is closely related to preoperative examination, radiological imaging reading , and operation skills.%目的 回顾性分析我院152例187节胸腰椎骨折椎体成形术后患者(PVP或PKP)骨水泥渗漏的发生率及预防措施.方法 2007年5月～2012年5月共152例骨质疏松性胸腰椎体压缩性骨折(187节椎体)患者施行经皮椎体成形术(PVP)75节或经皮椎体后凸成形术(PKP)112节,术后对责任椎常规复查CT,统计显示骨水泥渗漏共65节(34.76%),其中PVP术38节(50.66%),PKP术27节(24.11%),渗漏至椎管内15节(8.02%,PVP术9节,PKP术6节)、椎间隙内13节(6.95%,PVP术7节,PKP术6节)、穿刺针道内8节(4.28%,PVP术4节,PKP术4节)、椎间静脉渗漏5节(2.67%,均为PVP节)、椎体周缘(椎体前缘、椎体旁)23节(12.30%,PVP术12节,PKP术11节)、神经根管内1节(0.53%,为PVP术),观察术后疗效,总结造成骨水泥渗漏的原因及预防方法.结果 所有患者术后疼痛明显减轻,出现骨水泥渗漏并发症的患者中,1例渗漏至神经根管内患者出现神经压迫症状,减压术后症状缓解,其余患者术后均无明显神经压迫症状.结论 椎体成形术后渗漏发生率较高(34.76%),以椎体周缘渗漏(35.38%)最为常见,但因渗漏而有临床症状者较少(1.53%).骨水泥渗漏与术前检查是否充分、术前阅片是否仔细、手术操作是否熟练密切相关.