球囊扩张椎体后凸成形术中易出现的并发症及预防

The common problems during the operation of percutaneous kyphoplasty and relative solutions

目的:探讨球囊扩张椎体后凸成形术中易出现的并发症及预防措施。方法:2007年5月～2009年12月,32例50个椎体压缩性骨折患者于本科接受球囊扩张椎体后凸成型术,所有手术都在X线透视下进行,经皮置入工作管路,既而进行球囊撑开和骨水泥固定。手术可以选择单侧或双侧入路,注意避免球囊将椎体撑破,以及发生骨水泥渗漏和复位不良。结果:32名患者术后很快疼痛消失,但有8个椎体发生了骨水泥渗漏,并且对于椎体高度恢复的情况,10个椎体无明显变化,20个恢复超过50%,16个几乎完全恢复,4个仅有椎体前高恢复。结论:球囊扩张椎体后凸成形术可以有效地治疗老年人的骨质疏松椎体压缩性骨折,还能明显降低由于卧床带来的并发症,手术应该尽早进行,重点应放在治疗疼痛,而不是骨折的复位。掌握好椎弓根穿刺、球囊扩张技术以及把握好骨水泥的推注时机是取得手术成功,降低并发症的关键。

Objective：To investigate the common problems during the operation of kyphoplasty and relative solutions. Methods：From May 2007 to Dec 2009,50 cases of osteoporotic vertebral compression fractures（VCF） had undergone the kyphoplasty in our department.The working canals were inserted into the injured vertebral bodies percutaneously either trans-pedicularly or trans-vertebrally,which was followed by balloon distraction and bone cement fixation in order. The op-eration could be performed uni or bilaterally with great care to avoid the vertebral body compromise,bone cement leakage and failure of reduction.Results：The pain was relieved soon after operation in 32 cases,while bone cement leakage occurred in 8 cases.As far as the restoration of the height of vertebrae was concerned,no change happened in 10 vertebral bodies,more than 50% in 20,almost completely in 16 and only anterior column improvement in 4.Conclusion：Kyphoplsty is a very effective technique for the treatment of osteoporotic VCF in old patients,which can reduce the morbidity from recumbence remarkably.Moreover,the operation should be performed as earlier as possible,whose pain-killing effect should be paid more attention to than its function of reduction.