经皮椎体后凸成形术治疗骨质疏松性胸腰椎压缩性骨折的并发症及预防  

The complications and prevention of percutaneous vertebral kyphoplasty for the treatment of the thoracic and lumbar osteoporotic compression fractures during the operation

作　　者：王锡三[1] 刘赫[1] 胡广询[1] 罗妩[1] 李莉[1] 方永琴[1] 麦慧英[1] 

机构地区：[1]广东医学院附属南山医院骨二科,518052

出　　处：《中华内分泌外科杂志》2013年第3期226-230,共5页Chinese Journal of Endocrine Surgery

摘　　要：目的探讨经皮椎体后凸成形术（pereutaneous kyphoplasty，PKP）治疗骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fracture，OVCFs）的并发症及预防措施。方法2004年1月至2012年12月期间在广东医学院附属南山医院采取PKP及PKP合并椎体成形术（percutaneous vertebroplasty，PVP）治疗的OVCFs112例，共126个椎体。回顾性总结治疗中的各种并发症及其发生比例，分析其原因及预防措施。结果围手术期的并发症总发生率为54％，骨水泥渗漏66例（占52．4％），其中1例椎管内渗漏术后出现高热，对症治疗1周后症状消失，未出现神经损伤症状，其他渗漏多数发生在椎前渗漏，少数出现终板破裂渗漏及椎板后渗漏。所有患者均无肺栓塞发生，未出现骨水泥的毒性反应，无穿刺导致动脉、神经根损伤，暂时性脊髓损伤1例，椎体穿刺错误1例，球囊破裂1例，疼痛缓解不明显1例，无术后感染病例。结论骨水泥渗漏是PKP治疗OVCFs中最常见的并发症，其他并发症发生较少。严格掌握手术指征，把握骨水泥的填充量，提高手术技巧，以明显减少并发症的发生。Objective To discuss the complications of percutaneous kyphoplasty （PKP） in treatment of osteoporotic compression fractures （OVCFs） of the thoracic and lumbar vertebrae, and to investigate their causes and prevention. Methods From Jan. 2004 to Dec. 2012, PKP or PKP combined with percutaneous vertebroplasty（PVP） was performed on 126 vertebrae in 112 thoracolumbar OVCFs patients. There were 21 males and 91 females. The average age was 69 years （ranging from 36 to 85）. 100 cases had single vertebra, 10 cases had double vertebrae, and 2 cases had 3 vertebrae. The injured segments were identified by MRI before surgery, and the fractures of the vertebrae were observed clearly by X ray and CT scan. The causes of the complications were retrospective analyzed. Results Perioperative complication happened in 68 cases （54%）. The leakage of the bone cement happened in 66 cases （52. 4% ） ：one of them had high fever after the leakage happened behind the post-wall of the vertebra body, and it disappeared after one week with the relevant treatment. There was no injury of the nerve. Most of the leakage happened in front of the vertebra body, few happened in the terminal plate, and few happened behind the vertebral plate. There was no pulmonary embolism. Toxic reaction of the bone cement wasn＇t found in this team. There was no artery or nerve injury. One temporary spinal cord injury happened, one case was punctured in a wrong vertebra, and balloon rupture happened in one case. One case didn＇t achieve pain release. No infection happened. Conclusion The bone cement leakage was the most common complication associated with PKP in treatment of OVCFs. The complication rate can be reduced if the operation indications are strict, the volume of the filling cementis is well controlled, and the operation is performed in experienced hands.

关 键 词：经皮穿刺椎体后凸成形术 骨质疏松 胸腰椎压缩性骨折 并发症 预防 

分 类 号：R687.3[医药卫生—骨科学]