椎体后凸成形术治疗骨质疏松性胸腰椎压缩骨折的非骨水泥渗漏相关并发症  

Complications of percutaneous kyphoplasty non-related with bone leakage in treating osteoporotic thoracolumbar vertebral compression fractures

作　　者：茹选良[1] 蒋增辉[1] 桂先革[1] 孙启才[1] 宋柏杉[1] 林杭[1] 何荐[1] 

机构地区：[1]浙江医院骨科,浙江杭州310013

出　　处：《中国骨伤》2015年第8期763-767,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的：分析椎体后凸成形术治疗骨质疏松性胸腰椎压缩骨折的非骨水泥渗漏相关并发症。方法：自2008年10月至2012年10月,178例胸腰椎压缩骨折患者,在局麻下行椎体后凸成形术治疗;其中男72例,女106例;年龄58~92岁,平均75.3岁。共224节椎体,胸椎93节,腰椎131节。对患者术中及术后出现的并发症进行记录,分析椎体后凸成形术非骨水泥渗漏相关并发症。结果：所有患者顺利完成手术,无死亡病例。随访时间12~60个月,平均26.2个月。发生骨水泥渗漏27例,占15.1%;非骨水泥渗漏相关并发症15例,其中心脏骤停1例,经心肺复苏,抢救成功,无后遗症;呼吸暂停1例,经抢救恢复;血压下降、心率减慢3例;肠梗阻1例;局部血肿2例;肋间神经痛1例;骨水泥致椎体骨折分离2例;邻椎骨折4例。结论：非骨水泥渗漏相关并发症不常见,心肺并发症是椎体后凸成形术中风险最大的非骨水泥渗漏相关并发症,其可能原因与骨水泥的毒性、神经反射、脂肪栓塞以及椎体内压力变化有关。Objective：To analyze the complications of percutaneous kyphoplasty except bone leakge for the treatment of osteoporotic thoracolumbar vertebral compression fractures. Methods：From October 2008 to October 2012,178 patients with224 osteoporotic vertebral compression fractures were treated with percutaneous kyphoplasty under local anethsia. There were72 males and 106 females,ranging in age from 58 to 92 years old,with an average of 75.3 years,including 93 thoracic vertebrae and 131 lumbar vertebrae. The complications except bone cement leakage were analyzed during operation and after operation. Results：All operations were successful and all patients were followed up from 12 to 60 months with an average of 26.2months. No death was found. Bone cement leakage occurred in 27 cases,about 15.1% in 178 cases;and complications except bone cement leakage occurred in 15 cases. There was 1 case with cardiac arrest,was completely recovery by cardiopulmonary resuscitation（CPR） immediately; and 1 case with temporary absence of breathing,was recovery after treatment. There were 3cases with fall of blood pressure and slower of heart rate;1 case with intestinal obstruction;2 cases with local hematoma and 1case with intercostal neuralgia. Vertebral body fractures of 2 cases were split by bone cement and the fractures of adjacent body occurred in 4 cases. Conclusion：It＇s uncommon complication except bone cement leakge in treatment of osteoporotic thoracolumbar vertebral compression fractures with percutaneous kyphoplasty. The complication of cardiopulmonary system is a high risk in surgery; and cytotoxicity of bone cement,nervous reflex,fat embolism and alteration of intravertebral pressure may be main reasons.

关 键 词：骨质疏松 椎体后凸成形术 脊柱骨折 骨水泥 

分 类 号：R687.3[医药卫生—骨科学]