经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折中骨水泥渗漏的防治

PREVENTION AND TREATMENT OF BONE CEMENT LEAKAGE IN PERCUTANEOUS KYPHOPLASTY FOR OSTEOPOROTIC VERTEBRAL BODY COMPRESSION FRACTURE

目的总结应用经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral body compression fracture,OVCF)中骨水泥渗漏的原因及防治措施。方法2003年4月-2007年11月,采用PKP治疗OVCF116例,其中男57例,女59例;年龄65～92岁,平均67.7岁。均为外伤引起的腰背部疼痛,病程1～14d,平均5.7d。压缩骨折椎体共159个,单个椎体83例,2个椎体24例,3个椎体8例,4个椎体1例。术前影像学检查示均符合OVCF表现,椎体后壁无破坏,无脊髓和神经根受损症状。术中单个椎体骨水泥注入量3.5～7.1mL,平均4.8mL。结果手术时间30～90min,平均48min。术后患者疼痛明显缓解。术后第2天摄X线片复查,病椎复位满意,未见椎体进一步压缩、变形,骨水泥分布均匀。其中有14个椎体发生骨水泥渗漏,渗漏至椎体前方4个椎体,至椎体侧方4个椎体,至椎体后方3个椎体,至椎间盘2个椎体,至椎管1个椎体。渗漏原因与患者的选择、术者操作规范程度及骨水泥注入时机等有关。患者均获随访,随访时间12～30个月,平均24个月。均恢复伤前生活方式,无疼痛及其他并发症发生,未见医源性椎管狭窄,伤椎高度无明显丢失。结论经皮球囊扩张PKP治疗OVCF是一种安全有效的微创手术,严格选择有良好适应证的患者、提高骨水泥黏度及合适的注射剂量,以及术中精确定位等方法可减少骨水泥渗漏的发生。

Objective To investigate the causes and preventive methods of the bone cement leakage in percutaneous kyphoplasty （PKP） for osteoporotic vertebral body compression fracture （OVCF）. Methods From April 2003 to November 2007, 116 patients with OVCF were treated with PKP, including 57 males and 59 females aged 65-92 years old （average 67.7 years old）. All the patients suffered from trauma and the course of disease was 1-14 days （average 5.7 days）. There were 159 compressed and fractured vertebral bodies, including one vertebral body in 83 cases, two vertebral bodies in 24 cases, three vertebral bodies in 8 cases, and four vertebral bodies in 1 case. The diagnosis of OVCF was confirmed by imaging examination before operation. All the patients had intact posterior vertebral walls, without symptoms of spinal and nerve root injury. During operation, 3.5-7.1 mL bone cement （average 4.8 mL） was injected into single vertebral body. Results The operation time was 30-90 minutes （average 48 minutes）. Obvious pain rel ief was achieved in all the patients after operation. X-rays examination 2 days after operation revealed that the injured vertebral bodies were well replaced without further compression and deformation, and the bone cement was evenly distributed. Fourteen vertebral bodies had bone cement leakage （4 of anterior leakage, 4 of lateral leakage, 3 of posterior leakage, 2 of intervertebral leakage, 1 of spinal canal leakage）. The reason for the bone cement leakage included the individual ity of patient, the standardization of manipulation and the time of injecting bone cement. During the follow-up period of 12-30 months （average 24 months）, all the patients got their normal l ife back, without pain, operation-induced spinal canal stenosis, obvious height loss of injured vertebral bodies and other compl ications. Conclusion For OVCF, PKP is a mini-invasive, effective and safe procedure that provides pain rel ief and stabil ization of spinal stabil ity. The occurrence of bone cement leakages can be reduced by choosing the suitable case, improving the viscosity of bone cement, injecting the proper amount of bone cement and precise location during operation.