经皮椎体后凸成形术治疗椎体压缩性骨折围手术期并发症分析

Perioperative complications of percutaneous kyphoplasty for vertebral compression fracture

目的:分析经皮椎体后凸成形术(PKP)治疗椎体压缩性骨折的围手术期并发症发生情况。方法:2006年11月～2008年12月采用PKP治疗53例椎体压缩性骨折患者,男20例,女33例;年龄56～76岁,平均65.3岁;单椎体骨折34例,双椎体骨折16例,三椎体骨折3例,共75个椎体,其中T1222个,T1119个,T107个,T71个,L118个,L24个,L33个,L41个。回顾总结其围手术期并发症发生情况。结果:共18例(34.0%)患者发生围手术期并发症,骨水泥相关并发症16例(30.2%),其中骨水泥渗漏7例,渗漏至椎间隙2例、椎旁软组织2例(1例引起左股神经症状)、椎体前方2例、椎弓根穿刺通道1例;骨水泥毒性反应4例,表现为短暂胸闷气短、血压下降,经静脉注射地塞米松10mg等处理后好转;手术椎体疼痛加重5例。非骨水泥相关并发症2例(3.8%),皆为穿刺引发神经症状,1例表现为右股前皮肤感觉减退,1例为左肋间神经痛。所有并发症经积极处理后均未导致严重后果。结论:PKP治疗椎体压缩性骨折的围手术期并发症并不少见,但有严重后果的并发症较少,应重视围手术期并发症的积极预防和处理。

Objective：To investigate the perioperative complications of percutaneous kyphoplasty（PKP） for vertebral compression fracture.Method：From November 2006 to December 2008,53 patients with vertebral compression fracture underwent PKP,there were 20 males and 33 females,with the age range from 56 to 76 years（average,65.3 years）;34 cases had one level fracture,16 cases had two levels fracture,3 cases had three levels involved,there were a total of 75 vertebrae involved,which including 22 in T12,19 in T11,7 in T10,1 in T7,18 in L1,4 in L2,3 in L3,1 in L4.The common perioperative complications were reviewed retrospectively.Result：Perioperative complications occored in 18 cases（34.0%）,with bone cement related complications in16 cases（30.2%） which included cement extravasations in 7 cases：intervertebral space leakage in 2 cases,paravertebral leakage in 2 cases（with 1 case complicating with femoral nerve irritation）,vertebral body leaking anteriorly in 2 cases,pedicle leakage in 1 case;bone cement toxic reaction in 4 cases,who presented with transient dyspnea,chest discomfort and blood pressure decrease,which resolved after administration of DXM.5 cases had transient aggravation of pain.Non-cement related neurological complications due to puncture process were noted in 2 cases（3.8%）,1 case had skin hypoesthesia in right anterior thigh,while the other case had left intercostal neuralgia.No serious complications were noted overall.Conclusion：Perioperative complications of percutaneous kyphoplasty for vertebral compression fracture are not uncommon,however serious complications are rare.More attention should be paid on perioperative prevention and management.