单侧椎弓根穿刺经皮椎体后凸成形术中骨水泥渗漏的防治

Causes and preven tive ways of the bone cement leakages in unipedicular approach Kyphoplasty for osteoporotic vertebral body compression fractures

目的:探讨2003年4月-2008年1月应用单侧椎弓根穿刺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原因,防治骨水泥渗漏。方法:本组43例患者,男27例,女16例;年龄65～92岁,平均67.7岁;均为骨质疏松性椎体压缩骨折,共66个椎体,采用单侧椎弓根穿刺经皮球囊扩张椎体后凸成形术,最多一次穿刺四个椎体。根据X线片对骨水泥渗漏的原因分析。结果:全部病例疼痛完全解除或者有明显缓解,66个椎体共5个椎体发生骨水泥渗漏,发生率7.6%,所有病例均随访6个月以上,无不良后果发生。结论:单侧椎弓根穿刺经皮球囊扩张椎体后凸成形术治疗骨质疏松性椎体压缩骨折是一种有效、安全的微创手术,能够迅速地改善临床症状,骨水泥渗漏是其主要并发症,但一般无不良后果发生,只要病例选择合适,手术操作规范,骨水泥渗漏是可以避免的。

Objective：To explore the causes and preventive ways of the bone cement leakages in a single balloon cross-midline expansion via unipedicular approach Kyphoplasty for osteoporotie vertebral body compression fractures from April 2003 to January 2008. Methods：Forty-three patients（27 male 16 female） of osteoporotic vertebral body compression fractures（range 65 to 92,average 67.7 years old） were treated with unilateral transpedicular puncture of PKP. The total vertebral body was 66. The bone cement leakages were analyzed of the postoperative X-ray films. The causes, dangerousness and the prevention of the leakages of bone cement were analyzes. Results： Marked or complete pain relief was achieved in all patients. Five vertebral bodies of 66 were showed bone cement leakage （incidence rate was 7.6%）. All the patients were followed up for at least 6 months, there were no mal-onteomes. Conclusion： Unilateral transpedicular puncture of percutaneous kyphoplasty （PKP）is a minimally invasive, effective and safe procedure that provides pain relief and stabilization of spinal stability. Bone cement leakages are the main complications in the unilateral transpedicular puncture of Kyphoplasty, as long as choosing the suitable cases, obeying specification of the surgical procedures, the leakages of cement might be avoided.