经皮后凸成形术后骨水泥渗漏原因剖析  

Analysis of Bone Cement Leakage after Percutaneous Kyphoplasty

作　　者：张旭东[1] 李洋 云利兵[1] 刘敏[1] 王青[2] 易旭夫[1] ZHANG Xu-dong;LI Yang;YUN Li-bing;LIU Min;WANG Qing;Yi Xu-fu(Department of Forensic Pathology,West China School of Preclinical and Forensic Medicine,Sichuan University,Chengdu 610041,China;the People's Procuratorate of Pixian,Pixian,Sichuan 611730,China)

机构地区：[1]四川大学华西基础医学与法医学院法医病理教研室,成都610041 [2]郫县人民检察院,四川郫县611730

出　　处：《临床误诊误治》2018年第3期48-51,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨经皮后凸成形术(percutaneous kyphoplasty,PKP)后骨水泥渗漏的原因,减少漏诊漏治。方法对骨质疏松性椎体压缩性骨折(osteoporotic vertebral body compression fractures,OVCFs)行PKP术后骨水泥渗漏致左下肢神经功能障碍的医疗纠纷案例进行回顾性分析。结果本例因摔伤致腰部肿痛伴活动受限3 h就诊。诊断为腰1椎体新鲜骨折、腰2椎体陈旧骨折伴再次骨折。入院第3天行PKP手术,术后9 d患者出现左下肢麻木等症状,予营养神经等治疗,症状稍缓解出院。术后48 d患者因左大腿麻木无力伴活动障碍再次入院,行椎板切除减压术,术中证实骨水泥突入椎管内致硬膜囊受压变形,患者遗留左下肢活动障碍,进而引发医疗纠纷。结论 PKP术前要全面了解患者基础情况,术后及时评估术椎骨水泥分布,必要时予以外科探查,避免或减少神经损害恶性后果的发生。Objective To explore the causes of bone cement leakage after percutaneous kyphoplasty(PKP),thus preventing misdiagnosis.Methods We conducted a retrospective analysis on a medical dispute case regarding neurological dysfunction of left lower limb caused by bone cement leakage after conducting PKP for osteoporotic vertebral body compression fractures(OVCFs).Results This patient presented with pain and swelling of waist,accompanied with restricted movement for 3 h due to falls.The patient was diagnosed as having fresh fracture in first lumbar vertebra and old fracture in second lumbar vertebra.The PKP surgery was conducted on the third day of hospitalization.At 9 days after surgery,left lower limb numbness was noted,which was ameliorated with neurotrophic treatment,and the patient was then discharged home.The patient was rehospitalized 48 days after surgery because of left lower limb numbness with activity restriction,and underwent laminectomy.Bone cement was intraoperatively confirmed to leak into spinal canal,leading to deformation of dural sac.This caused activity restriction in left lower limb,which induced medical dispute.Conclusion Prior to PKP surgery,it is of great significance to have a thorough understanding and analysis of pathogenic conditions of patients.After surgery,it is necessary to timely evaluate distribution of vertebra bone cement and perform surgical examination if necessary to prevent or reduce neurological damage.

关 键 词：骨质疏松性骨折 骨折 压缩性 经皮后凸成形术 手术后并发症 

分 类 号：R683[医药卫生—骨科学]