经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的并发症分析

Analysis of complications of kyphoplasty for osteoporotic vertebral compression fractures

目的：总结经皮椎体后凸成形术（percutaneous kyphoplasty,PKP）治疗骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fractures,OVCFs）的并发症,探讨其发生原因及其预防措施。方法：2004年9月~2009年6月,采用PKP治疗OVCFs患者115例,男24例,女91例,年龄52～83岁,平均68岁;单椎体83例,双椎体24例,3椎体5例,4椎体2例,5椎体1例;术前均由MRI STIR序列确定伤椎节段,T6 1个,T7 2个,T8 2个,T9 8个,T10 9个,T11 24个,T12 44个,L1 41个,L2 18个,L3 5个,L4 3个,L5 2个。回顾总结其并发症发生情况,分析其并发症的发生原因。结果：115例患者中21例发生并发症,发生率为18.2%。其中骨水泥渗漏13例（11.3%）,术中球囊破裂3例（2.6%）,穿刺入椎管2例（1.7%）,取出球囊病椎高度丢失2例（1.7%）,术后病椎塌陷1例（0.9%）,均无严重神经损害,未出现感染、硬膜外血肿及肺栓塞等并发症。结论：PKP治疗OVCFs常见的并发症包括骨水泥渗漏、球囊破裂、穿刺入椎管、术中病椎高度丢失、术后病椎再塌陷等,术中及术后应采取相应的防范措施,预防或减少并发症的发生。

Objectives： To Summarize the complications of percutaneous kyphoplasty（PKP） for osteoporotic vertebral compression fractures（OVCFs）,and to investigate its causes and prevention.Methods： From September 2004 to June 2009,the PKP was performed on 115 OVCFs patients.There were 24 males and 91 females,with an average age of 68 years（range,52-83 years）.83 cases had single vertebra,24 cases had double vertebrae,5 cases had 3 vertebrae,2 cases had 4 vertebrae,1 case had 5 vertebrae involved.Preoperative MRI STIR sequence was used to determine injured segment,including 1 in T6,2 in T7,2 in T8,8 in T9,9 in T10,24 in T11,44 in T12,41 in L1,18 in L2,5 in L3,3 in L4,2 in L5.The complications and causes were analyzed.Results： A total of 21 cases was noted complications,with the rate of occurrence of 18.2%.Bone cement leakage was noted in 13 cases（11.3%）;intraoperative balloon rupture in 3 cases（2.6%）;perforation into the spinal canal in 2 cases（1.7%）;loss of height in 2 cases（1.7%）;postoperative vertebral collapse 1 cases（0.9%）.No severe neurological deficit,epidural hematoma or pulmonary embolism was noted.Conclusions： The complications associated with PKP treatment include bone cement leakage,balloon rupture,perforation into the spinal canal,vertebral height loss,postoperative vertebral collapse,which should be managed by corresponding preventions.