经皮椎体成形和经皮椎体后凸成形治疗中的骨水泥渗漏  

Bone cement leakage during percutaneous vertebroplasty and percutaneous kyphoplasty

作　　者：姚晓光[1] 张文武[1] 刘连涛[1] 马树伟[1] 申勇[1] 

机构地区：[1]河北医科大学第三医院脊柱外科,河北省骨科研究所,河北省石家庄市050051

出　　处：《中国组织工程研究》2012年第51期9645-9649,共5页Chinese Journal of Tissue Engineering Research

摘　　要：背景:经皮椎体成形和经皮椎体后凸成形是近年来微创脊柱外科常用的技术,随着其临床应用越来越多,主要并发症骨水泥渗漏也越来越多地见于临床报道。目的:综述经皮椎体成形和经皮椎体后凸成形治疗中骨水泥渗漏的研究进展。方法:由第一作者检索2000至2011年PubMed数据及万方数据库有关经皮椎体后凸成形和经皮椎体成形治疗骨水泥渗漏的分类、相关危险因素、对机体的影响、防治等方面的文献。结果与结论:经皮椎体后凸成形治疗的骨水泥渗漏率低于经皮椎体成形治疗。注射少量骨水泥即可恢复压缩椎体的刚度,一般腰椎注射4-6mL,胸椎可适当加大剂量。术者需准确把握骨水泥的注射时机,注入调制后时间>10min的骨水泥,骨水泥呈面团状,渗漏率低。椎体周壁破损时行两种治疗发生骨水泥渗漏的概率增大。两者骨水泥渗漏引起肺栓塞的概率较低,但一旦发生,后果严重,对心血管系统也有一定影响,因此,需严格掌握手术适应证,正确选择进针点和穿刺入路,严格把握骨水泥的注射时机和剂量,以精确的术中操作和优质的术中监测将骨水泥渗漏风险降至最低。BACKGROUND：Percutaneous vertebroplasty and percutaneous kyphoplasty are commonly used in minimally invasive spine surgery in recent years. However, with the clinical development, bone cement leakage that is the main complication of percutaneous vertebroplasty and percutaneous kyphoplasty is also increasingly found in clinical reports. OBJECTIVE：To review the research progress in bone cement leakage during percutaneous vertebroplasty and percutaneous kyphoplasty. METHODS：The articles （2000/2011） about classification, related risk factors, the influence on the body, prevention and cure related to bone cement leakage during percutaneous vertebroplasty and percutaneous kyphoplasty were retrieved by the first author in the PubMed and Wanfang databases. RESULTS AND CONCLUSION：Percutaneous kyphoplasty has a lower rate of bone cement leakage compared with percutaneous vertebroplasty. A small dosage of bone cement injection can restore the stiffness of the compressed vertebral. For the lumbar vertebra, 4 to 6 mL bone cement is enough. The injection dose can be increased for the thoracic vertebrae. Surgeons need to grasp the opportunity of bone cement injection. When we inject the bone cement over 10 minutes after modulation, the leakage rate of bone cement is low. When the vertebral wall is incomplete, the cement leakage rate is increased in the percutaneous vertebroplasty and percutaneous kyphoplasty. The chance of pulmonary embolism caused by bone cement leakage during percutaneous vertebroplasty and percutaneous kyphoplasty is low. But if it happens, it could lead to serious consequences, and also has certain effects on the cardiovascular system. Therefore, we must grasp the operation indication strictly, and choose the right entry point and the puncture path. We should control the dosage of bone cement and the injection timing correctly by precise operation and high-quality intraoperative monitoring to minimize the risk of bone cement leakage.

关 键 词：经皮椎体后凸成形 经皮椎体成形 骨水泥渗漏 注射剂量 概率 生物材料 

分 类 号：R318[医药卫生—生物医学工程]