椎体后凸成形术治疗老年骨质疏松性椎体骨折的并发症及对策  

Complications and their prevention strategies of percutaneous kyphoplasty for osteoporotic vertebral compression fractures in the elderly

作　　者：宋海涛[1] 张伟[1] 李民[1] 高卫良 吴玉泉[1] 曲邵政 刘彦斌[1] 盛文博 SONG Hai-tao;ZHANG Wei;LI Min;GAO Wei-liang;WU Yu-quan;QU Shao-zheng;LIU Van- bin;SHENG Wen-bo(Department of Spinal Surgery,107^th Hospital of PLA,Yantai 264000,China)

机构地区：[1]中国人民解放军第一0七医院脊柱外科,山东烟台264000

出　　处：《中国矫形外科杂志》2018年第14期1288-1291,共4页Orthopedic Journal of China

摘　　要：[目的]分析经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗老年骨质疏松性椎体骨折(osteoporotic vertebral compression fractures,OVCFs)过程中的并发症,探讨发生原因及预防对策。[方法]回顾性研究2013年12月～2017年12月,采用PKP治疗OVCFs患者577例共621个椎体。将并发症的发生以骨水泥注入椎体内为时间节点,分为骨水泥注射前并发症、骨水泥注射过程中并发症及骨水泥注射后遗留并发症三种情况,术后随访2～31个月,平均(18.42±2.43)个月。[结果]骨水泥注入量胸椎平均(3.60±1.50)ml,腰椎平均(5.80±1.90)ml;共出现各种并发症89例,总体发生率为15.42%,其中在骨水泥注射前发生10例(11.24%):局麻导致全脊髓麻醉1例,穿刺导致脊髓休克1例、肋间神经不完全损伤3例、肋骨骨折1例、脑脊液漏1例、球囊扩张过程中一过性高血压3例;注射期间发生65例(73.03%):骨水泥渗漏到椎体外52例,呼吸困难、血压下降8例,一过性疼痛加重5例;注射后期发生14例(15.73%):骨水泥拖尾导致局部异物感4例,疼痛症状加重3例,术后发热7例;各种并发症中以骨水泥渗漏相关并发症最为多见,占比58.43%(52/89);发生并发症后紧急后路椎板切除神经减压2例、手术延期6例、暂停翻身观察后继续手术11例、对症处理16例。[结论]应用PKP治疗OVCFs除应关注骨水泥渗漏的并发症外,还应重视围骨水泥灌注期的并发症,给予积极预防和及时处置。[Objective] To analyze the complications, their reasons and the prevention strategy of percutaneous kyphoplasty （PKP） for osteoporotic vertebral compression fractures （OVCFs） in the elderly [Methods] From December 2013 to December 2017, 577 patients, including 105 males and 472 females aged from 60 to 94 years, underwent PKP for OVCFs involving 621 vertebrae in our department . In terms of timeline of cement injection, the complications were divided into those before, during and after injecting cement. All patients were followed up for 2 to 31 months with an average of （18.42±2.43） months. [Results] The volume of bone cement injection was （3.60± 1.50） ml in the thoracic vertebrae, while （5.80± 1.90） ml in the lumbar spine respectively. Complications were totally noted in 89 patients （15.42%） . Of them, 10 cases （11.24%） occurred before injecting cement, including 1 case of total spinal blocked by local anesthesia, 1 case of spinal shocked by puncturing, 3 cases of intercostal nerve incompletely damaged, 1 case of rib fracture, lcase of leakage of cerebrospinal fluid, and 3 cases of transient hypertension; 65 cases （73.03%） happened during cement injection, such as 52 cases of bone cement leakage out of the fractured vertebrae, 8 cases of dyspnea and hypotension, as well as 5 cases of transient pain aggravating at operation theatre; 14 cases （15.73%） took place after cement injection, including 4 cases of foreign body sensation at back by cement leaving behind, 3 case of back pain aggravating and 7 cases of fever. The complications associated with cement leakage were the most common, accounted for 58.43% （52/89） . As the complications happened, 2 patients received emergency posterior lamineetomy decompression, 6 patients were turned to delayed operation and 11 patients continued to be operated after proper observation with positionpay attention not only during cement injection, but also before and after cement injection and take a active prevention and timely treatment of

关 键 词：骨质疏松症 椎体压缩骨折 经皮椎体后凸成形术 骨水泥灌注 并发症 

分 类 号：R683.2[医药卫生—骨科学]