老年压缩性椎体骨折椎体成形术骨水泥外溢15例影像学分析

Analysis of the bone cement leakage during the vertebroplasty on 15 elder patients suffering osteoporotic vertebral compressive fracture

目的探讨老年骨质疏松椎体压缩骨折椎体成形术中出现骨水泥外溢情况及对策。方法2006年1月—2008年12月我院行椎体成形术151例,骨水泥外溢15例(9.93%),其中外溢到邻近椎间隙5例、椎管周围软组织8例、椎体血管内2例。结果15例患者均出现不同程度的疼痛、酸胀、灼热感及下坠感等症状。全部予以对症治疗,1～3年后观察,13例患者术后有效地恢复了椎体的高度和终板的完整性,增加了脊柱的稳定性,X线复查外溢的骨水泥无吸收,但疼痛灼热感消失,活动恢复正常。外溢到椎体血管者椎体高度丢失2例(30.0%),术后2年观察腰部仍有疼痛和下坠感。结论椎体成形术是治疗骨质疏松性椎体压缩骨折的有效方法,但术中一定要规范操作,高度注意防止骨水泥外溢。

Objective To investigate the cause and solution of bone cement leakage in the process of the vertebroplasty in aging osteoporotic vertebral compressive fracture patients. Methods We studied 151 vertebroplasty cases in our hospital from January. 2006 to December 2008 and found that there was bone cement leakage in 15 patients＇ waists, accounting for 9.93%, five of whom in neighboring intervertebral space, eight in soft tissue around vertebral canals and two in the vertebral blood vessels. Results Among the 15 vertebroplasty cases,all patients with the bone cement leakage felt,in varying degrees pain, feeble, scorching and lumbersome in their waists. After one to three years＇observation, the vertebral height of 13 patients was not recovered completely, but they did not feel pain or scorching any more and they could move around without obvious limitation. After the vertebroplasty, their vertebral height and lamina terminalis completeness recovered effectively and stableness of their vertebral columns increased significantly. Nevertheless, following up X-ray shuwed that the leaked bone cement was not absorbed. For the two pa- tients with the bone cement leakage in their vertebral blood vessels, their vertebral heights lost and the rate was 30.0%. Two years after the vertebroplasty,they still feel pain and lumbersome in their waists. Conclusion The vertebroplasty was an efficient way to treat the osteoporotic vertebral compressive fractures. During the vertebroplasty, however,the operation must be normative and more attention should be paid to prevent bone cement leakage.