经皮椎体成形骨水泥渗漏的治疗与预防  

Prevention and treatment of cement leakage in percutaneous vertebroplasty

作　　者：闫光华[1] 葛顺杰[1] 仇继任[1] 陆茂德[1] Yan Guang-hua;Ge Shun-jie;Qiu Ji-ren;Lu Mao-de(Department of Orthopedics,Second People’s Hospital of Qinzhou,Qinzhou 535000,Guangxi Zhuang Autonomous Region,Chin)

机构地区：[1]广西钦州市第二人民医院骨二科,广西壮族自治区钦州市535000

出　　处：《中国组织工程研究》2018年第26期4241-4246,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:经皮椎体成形具有手术创伤小、止痛效果好等特点,且可增加椎体强度、稳定椎体,目前已被广泛应用于临床,但其手术并发症骨水泥渗漏发生率较高。目的:归纳总结经皮椎体成形骨水泥渗漏的治疗与预防。方法:应用计算机检索Pub Med数据1999年1月至2017年6月发表的文献,检索词为"Percutaneous Vertebroplasty;Bone Cement Leakage;Prevention and Treatment";检索中国知网2006年5月至2017年7月发表的文献,检索词为"经皮椎体成形术;骨水泥渗漏;预防及治疗"。结果与结论:为减少骨水泥渗漏的发生,应注意以下几项:术前详细查体并询问病史,完善影像学检查,严格掌握手术适应证及禁忌证;术中选择合适的穿刺路径、全程C臂透视并与患者充分交流;尽可能使用高黏度的骨水泥,并在面团期注入适量骨水泥;骨水泥灌注结束后静置数分钟后再拔针。大部分骨水泥渗漏无临床症状,有的仅表现为局部疼痛,保守对症治疗后多能恢复。对于一些灾难性后果,如骨水泥椎间孔渗漏压迫脊髓及神经,保守治疗不能彻底解除其压迫,必要时开放手术取出骨水泥。对于肺栓塞及下肢静脉栓塞等严重并发症,如症状不能缓解,则需手术取栓。BACKGROUND： Percutaneous vertebroplasty is characterized by small surgical trauma and good analgesic effect, and it can also increase the strength and stability of the vertebral body. Therefore, it has been widely used in clinical practice. However, postoperative bone cement leakage is still at high incidence. OBJECTIVE： To summarize the prevention and treatment of cement leakage in percutaneous vertebroplasty. METHODS： We retrieved PubMed for relevant articles published from January 1999 to June 2017. The key words were “percutaneous vertebroplasty; bone cement leakage; prevention and treatment”. We also retrieved CNKI database for relevant articles published from May 2006 to July 2017, with the key words of “percutaneous vertebroplasty; bone cement leakage; prevention and treatment” in Chinese. RESULTS AND CONCLUSION： In order to reduce the occurrence of the leakage of bone cement, there are somecautions as follows： （1） perform a detailed preoperative examination and inquire the medical history; （2） perfect imaging examination; （3） master the surgical indications and contraindications strictly; （4） choose the proper puncture path, and use C-arm perspective and communicate with patients during the operation; （5） use high-viscosity bone cement as much as possible, inject proper amount of bone cement in the dough consistency; and （6） pull the needle until a few minutes after the completion of the bone cement infusion. Cement leakage is asymptomatic in most cases, and some patients only feel local pain. Most patients can recur after the conservative treatment. Some catastrophic consequences, such as bone cement leakage via intervertebral pores, appear with the compression of the spinal cord and nerve, and conservative treatment cannot completely remove the compression. We should remove bone cement by open surgery if necessary. For serious complications such as pulmonary embolism and lower limb vein embolism, surgical treatments should be taken in the presence of unre

关 键 词：骨水泥渗漏 生物材料 骨科材料 经皮椎体成形 预防及治疗 

分 类 号：R318[医药卫生—生物医学工程]