骨质疏松性椎体压缩骨折椎体成形:漏诊、重度椎体压缩、骨水泥渗漏及再发骨折225例分析  

Vertebroplasty for osteoporotic vertebral compression fractures: missed diagnosis, severe vertebral compression, bone cement leakage and recurrent fractures in 225 cases

作　　者：张辉[1] 高中玉[1] 许财元 张同星[2] 张涛[1] 

机构地区：[1]天津市第一中心医院骨科,天津市300192 [2]天津医科大学一中心临床学院,天津市300192

出　　处：《中国组织工程研究》2016年第35期5256-5262,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:经皮椎体成形治疗骨质疏松性椎体压缩骨折取得了非常好的效果。目的:探讨胸腰椎椎体成形手术的相关问题与解决方案。方法:纳入骨质疏松性椎体压缩骨折患者225例,其中男78例,女147例,年龄53-92岁,均进行椎体成形治疗,观察并记录围手术期相关问题。结果与结论:6例(2.7%)发生漏诊,16例(7.1%)椎体压缩程度超过2/3,29例(12.9%)45个椎体(12.8%)发生骨水泥渗漏,10例(4.4%)出现再发骨折,79例(35.1%)出现多椎体骨折。1漏诊的应对策略:术前仔细查体,避免遗漏疼痛点,必要时加做可疑部位的MRI扫描;2重度椎体压缩的应对策略:尽量平行上下终板方向置入穿刺针、腰椎沿着椎弓根基地部穿刺、胸椎采用椎弓根外穿刺途径;3骨水泥渗漏的应对策略:术中发现超过终板上下缘的骨水泥影应立即将C型臂X光机转为前后位,确定渗漏方位后渗漏侧不再注入骨水泥,未渗漏侧应继续注入骨水泥以确保椎体内骨水泥的填充量;4再发骨折的应对侧略:再手术治疗;5多椎体骨折的应对策略:多椎体骨折的患者多具有体质弱、合并症多的特点,尽量缩短手术时间十分必要,术前应根据骨折的不同压缩程度制定单或双侧穿刺途径,以节约手术时间。BACKGROUND： Percutaneous vertebroplasty for treatment of osteoporotic vertebral compression fractures has achieved very good results. OBJECTIVE： To discuss and resolve some problems related to thoracic and lumbar vertebroplasty. METHODS： 225 patients （78 males and 147 females） aged 53 to 92 years old were included in this study. They all accepted percutaneous vertebrolplasty and we observed and made a record about some questions related this surgery during perioperative period. RESULTS AND CONCLUSION： Six cases （2.7%） missed diagnosis. More than two-third of the compression degree were found in sixteen cases （7.1%）. Forty-five （12.8%） vertebrae suffered from bone cement leakage in twenty-nine cases （12.9%）. Recurrent fractures appeared in ten cases （4.4%）. Multiple vertebrae fractures appeared in seventy-nine cases （35.1%）. （1） Strategies for missed diagnosis： conduct preoperative physical examination carefully; avoid missing the point of pain; increase MRI scanning when necessary. （2） Coping strategies for severe vertebral fractures： place the needle into the parallel endplates as far as possibly; puncture along the lumbar spine pedicle base and the lateral thoracic pedicle. （3） Coping strategies for cement leakage： when cement leakage over the lower edge of the end plate occurred in operation, we should immediately put the C-arm X-ray machine into anteroposterior position to determine the orientation of the leakage and stop injecting; we should continue to inject the bone cement into the no leak-side to ensure the filling amount of vertebral bone cement. （4） Coping strategies for recurrent fractures： reoperation. （5） Coping strategies for multiple fractures： patients with multiple fractures often have a feature of poor constitution and more complications. So, it is necessary to shorten the operation time, and determine unilateral or bilateral puncture ways depending on the degree of vertebral compression to save operation time. Subject headings�

关 键 词：椎体成形术 骨质疏松性骨折 组织工程 骨科植入物 脊柱植入物 骨质疏松性椎体压缩骨折 椎体成形 骨水泥渗漏 问题 对策 

分 类 号：R318[医药卫生—生物医学工程]