经皮穿刺椎体成形术后骨水泥渗漏的原因分析及预防

Cement Leakage Following Percutaneous Vertebroplasty

目的:分析经皮椎体成形术(PVP)治疗椎体压缩骨折患者术后发生骨水泥渗漏并发症的原因,并探讨有效的预防方法。方法:2008年至2011年对老年性椎体压缩骨折患者138例(158个椎体)行经皮椎体成形术,观察患者术后骨水泥渗漏的情况。结果:术后出现骨水泥渗漏共39个椎体,发生率24.7%。15例患者出现临床症状,其中9例因椎体内骨水泥含量不足,治疗效果术后不佳,5例椎体后壁存在轻度破损患者骨水泥渗漏至神经根管周围,出现单侧神经根刺激性症状,后行地塞米松以及神经营养治疗,症状缓解。1例出现针眼处疼痛,平卧后加重。结论:骨水泥渗漏与术前的病椎情况评估、术中的穿刺、注射和影像学监视等有关,严格把握手术适应证,熟练准确的手术操作、完善的影像学监测,均可有效预防经皮椎体成形治疗后骨水泥渗漏的发生。

Objective To evaluate the clinical observation and preventive measures for percutaneous vertebroplasty leakage complications due to vertebroplasty operative procedure on compression fracture of vertebral body.Methods One hundred and thirty-eight patients(158 vertebrae) with vertebral compression fracture were recruited,the leakage of bone cement was observed after PVP treatment.Results There were 39 vertebrae with various degrees of bone cement leakage with incidence being 24 %(39/158).There were 15 patients with clinical symptoms.Conclusion Preoperative morphological analysis and the judgement of fracture condition,the surgeon’s experience,option of surgical method and operative skills,and tools have important influence on PVP leakage.The controlling of these factors can markedly reduce the risk of PVP leakage.