椎体后凸成形术治疗骨质疏松性椎体压缩骨折的并发症及预防

Complications and the prevention of percutaneous kyphoplasty for osteoporotic vertebral compression fractures

目的：总结经皮椎体后凸成形术（percutaneouskyphoplasty，PKP）治疗骨质疏松性椎体压缩骨折（0steo—porotievertebralcompressionfractures，OVCFs）的并发症，探讨其发生原凶及预防措施．方法：2003年6月～2009年12月，采用PKP治疗OVCFs患者187例共233个椎体：所有病例术前均无神经根及脊髓受压症状．年龄52～93岁，男31例，女156例？椎体周壁破坏34例47个椎体，椎体周壁无破坏153例186个椎体：手术部位：T5～L5，TIO及以下椎体经椎弓根入路，T9及以卜椎体经椎弓根旁入路。术后随访2～78个月，平均20．8个月结果：患者手术均顺利完成：共出现并发症23例，发生率为123％。骨水泥渗漏7例共7个椎体，6例未产生临床症状，1例术后疼痛症状加重，口服消炎镇痛药3d后症状缓解；椎体周壁有破坏者和无破坏者骨水泥渗漏的发生率分别为8．5％（4／47）和1．6％（3／186），差异有显著性（P〈0．05）；有骨水泥渗漏患者骨水泥注入量胸椎为4．53±0．31ml，腰椎为6．75±0．42m1．无渗漏者胸椎为3．50±0．40ml，腰椎为5．60±0．60ml，有骨水泥渗漏与无骨水泥渗漏患者骨水泥注入量有显著性差异（P〈0．05）；不同手术入路和手术部位的骨水泥渗漏率无统计学差异（P〉0．05）。3例术中卅现一过性血压降低，紧急处理后30min内恢复正常。2例术后疼痛加重，分别服用消炎镇痛药2d、7d后症状缓解。术后发生低热5例，给予对症处理后体温均恢复正常。随访过程中非手术椎体新发压缩骨折6例，4例经保守治疗，2例行PKP手术后，均恢复日常活动。结论：PKP治疗OVCFs有一定的并发症，骨水泥渗漏仍是主要并发症，严格掌握手术适应证，提高手术技术水平可减少并发症的发生，

Objective：To summarized the complications and the prevention of percutaneous kyphoplasty（PKP） for osteoporotie vertebral compression fractures（OVCFs）.Method：From June 2003 to December 2009,a total of 233 vertebrae in 187 patients（31 males and 156 females） aged from 52 to 93 years underwent PKP.All cases presented with no neurological deficit.The peripheral wall of 47 vertebral bodies were noted broken in 34 cases,while 186 vertebral bodies in 153 cases were intact.The involved vertebrae included T5-LS,and transpedieular approach was performed in vertebrae below T10,while parapedicular approach was performed in vertebrae above T9.All patients were followed up for an average of 20.8 months （range,2-28 months）Result： Complications were noted in 23 cases（12.3%）.Bone cement leakage was noted in 7 vertebrae（7 cases）,and 6 cases had no symptoms. 1 case had no pain relief after operation,but the pain was alleviated after 3d NSAID administration.The bone cement leaking rase for broken and intact of peripheral wall was 8.5%（4/47） and 1.6%（3/186） respectively,which showed significant difference（P〈0.05）.The volume of bone cement injection in leaking vertebrae was 4.53±0.3lml and 6.75±0.42ml for thoracic spine and lumbar spine respectively,while 3.50±0.40ml and 5.60±0.60ml respectively for no leaking vertebrae,which showed significant difference be- tween 2 groups with regard to the volume of bone cement injection（P〈0.05）.No difference of approach-related and site-related bone cement leaking was noted （P〉0.05）.3 eases had transient hypertension,which was re-solved after corresponding intervention 30rain later,2 cases had no pain relief,which was resolved after administration of NSAID for 2d and 7d respectively,5 cases had fever,which was resolved after corresponding intervention.6 cases were noted fresh fracture in nonsurgical vertebrae,and 4 underwent conservative treatment and 2 underwent PKP again.All recovered to routine activity.Conclusion：Cement leakage is still the main and potential complication of PKP.It should be kept in mind that improved surgical technique and strict indication can ensure the success of PKP.