经皮球囊扩张椎体后凸成形术治疗骨质疏松性椎体压缩性骨折骨水泥渗漏的预防  

Prevention of Bone Cement Leakage in the Treatment of Osteoporotic Vertebral Compression Fractures with Percutaneous Kyphoplasty

作　　者：李停[1] 宋建东[1] 李志钢[1] 李长文[1] 

机构地区：[1]湖北省新华医院骨科,湖北武汉430015

出　　处：《武汉大学学报（医学版）》2014年第2期314-317,共4页Medical Journal of Wuhan University

摘　　要：目的:探讨经皮球囊扩张椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩性骨折骨水泥渗漏的预防措施。方法:2010年10月至2012年11月,115例(共137个椎体)骨质疏松性椎体压缩骨折患者行PKP治疗。术前、术后第2天及术后半年随访时分别进行视觉模拟疼痛评分(VAS)评价治疗效果。结果:所有手术均顺利完成。患者术后疼痛缓解满意,VAS评分由术前的(7.8±1.2)分下降至术后第2天的(2.7±0.7)分,术后半年随访时为(2.6±0.9)分。术后第2天与术前、术后半年与术前差别有显著性意义(P<0.05)。其中12例患者(共13个椎体)出现骨水泥渗漏,7个椎体出现椎旁软组织渗漏,2个椎体出现静脉渗漏,2个椎体出现椎间盘渗漏,2个椎体出现椎管渗漏。渗漏原因与手术适应证、术前准备、手术入路、手术操作、骨水泥的注射等有关。结论:PKP是治疗骨质疏松性椎体压缩性骨折的有效方法,虽然在术中可能出现骨水泥渗漏,给患者造成损害,但只要严格掌握手术适应证,认真进行术前准备,提高手术操作技巧与水平,骨水泥渗漏的并发症是可以避免的。Objective： To investigate the preventive methods of bone cement leakage in the treatment of osteoporotic vertebral compression fractures with pereutaneous kyphoplasty. Methods： 115 cases （137 vertebrae） of osteoporotic thoracolumbar compressive fractures were treated with percutaneous kyphoplasty from October 2010 to November 2012. The clinical effects were evaluated by observing the charges of visual analog scale（VAS） pre-operativeiy,post-operativeiy（two days after operation） and at the last follow-up（six months after operation）. Results： All cases were successfully treated. All patients＇ symptoms of pain were evidently relieved. VAS scale decreased from 7.8±1.2 preoperatively to 2.7±0.7 postoperatively, and 2.6±0.9 at final follow-up. 12 cases （13 vertebrae） were found bone cement leakage（7 of paravertebral soft tissue leakage, and 2 of vein leakage, 2 of intervertebral disc leakage, and 2 of canalis spinalis leakage）. The related factors of bone cement leakage included operation indications, preoperative preparation, operative approach, operative procedure and the technique of injecting bone cement. Conclusion： Percutaneous kyphoplasty is effective for osteoporotic vertebral compression fractures. Bone cement leakage will occur in operation and be hamrful to patients. It will be avoided if we strictly control operation indications, careful prepare before operation, and improve the skills of operative procedure and the technique of injecting bone cement.

关 键 词：经皮椎体后凸成形术 骨质疏松 椎体压缩性骨折 骨水泥渗漏 预防 

分 类 号：R683.2[医药卫生—骨科学]