椎体后凸成形术并发症的防治

Prevention and Treatment of Complications of Kyphoplasty

目的探讨椎体后凸成形术并发症发生的原因以及预防措施。方法通过回顾分析,2003年6月～2005年12月,笔者对41例(49节椎)骨质疏松性胸腰椎骨折行椎体后凸成形术。C型臂X线机透视下,经椎弓根穿刺到伤椎,球囊扩张后灌入骨水泥。根据术前、术中、术后影像学检查,分析手术并发症的原因。结果41例随访3～24个月,平均12.2个月。疼痛消失36例,留有轻度疼痛4例,疼痛无好转1例。40例对治疗满意,1例不满意。并发症:骨水泥漏7例,腰部穿刺部位血肿2例,肋间神经痛1例,不全性肠梗阻1例,骨水泥致椎体骨折1例。结论手术适应证的掌握和手术技术的提高是预防椎体后凸成形术并发症关键因素。

Objective To explore the cause and the measure of prevention and treatment of complications of kyphoplasty. Methods Retrospectively, 49 segments osteoporotic compression fractures of vertebral bodies in 41 patients were performed by kyphoplasty from Jun. 2003 to Dec. 2005. Under C- arm fluoroscopy and local anesthesia, the needle entry sites of pedicles were localized. After inflated, the gasbag restored the vertebral body back while a cavity that could be filled with bone cement. The procedures of surgeries were ana- lyzed and the X - ray, CT and MRI images were investigated. The complications of surgeries were discussed. Results Forty- one patients were followed up for 3 to 24 months, 12.2 months on average. The results were that 36 patients were pain free, 4 had slight pain, and 1 still had lumbar pain postoperatively. Forty patients were satisfied with the surgery while one was dissatisfied. Complications occurred in 7 patients with bone cement leakages, 1 with intercostals neuralgia, 2 with hematoma of entry sites of lumbar, 1 with incomplete intestine obstruction and 1 with the vertebral body facture caused by bone cement. Conclusion The suitable patients and improvement of surgical techniques are the two factors that the complications may be prevented in the kyphoplasty.