经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折围手术期并发症分析

Analysis of perioperative complications of percutaneous kyphoplasty for osteoporotic vertebral compression fracture

目的:分析经皮球囊椎体后凸成形术治疗骨质疏松性椎体压缩性骨折的围手术期并发症的发生情况。方法:收集2009年6月至2011年12月采用PKP方法治疗椎体压缩性骨折患者63例,其中男18例,女45例,年龄62～91岁,平均75.3岁。所有患者为外伤后腰背部严重疼痛,行走受限,但均无神经症状及体征。影像学检查(X线和MRI)证实为骨质疏松性椎体压缩性骨折。合并症:骨质疏松63例,高血压37例,冠心病10例,贫血29例,糖尿病26例,慢阻肺11例,胃炎及消化性溃疡8例。回顾总结分析其围手术期并发症发生情况。结果:在63例患者中,手术前并发症9例(14.3%),术中及术后并发症17例(26.9%)。其中手术前并发症包括:坠积性肺炎1例,电解质紊乱2例,尿路感染2例,中度贫血2例,电解质紊乱合并中度贫血1例,坠积性肺炎合并神智淡漠、谵妄1例。术中及术后并发症中,骨水泥相关并发症9例(14.3%),其中2例患者出现骨水泥毒性反应,7例发生骨水泥渗漏(2例出现相关临床症状);非骨水泥相关并发症3例(4.76%),穿刺局部血肿1例,一过性神经损伤1例,术后左侧肋间神经痛1例;所有患者中,共有5例患者(7.93%)术后出现一过性的痛觉过敏。所有并发症经积极处理后均未导致严重后果。结论:PKP治疗骨质疏松性椎体压缩性骨折的围手术期并发症并不少见,经积极处理一般无严重后果,应重视围手术期并发症的预防和处理。

Objective：To analyze the perioperative complications of percutaneous kyphoplasty （PKP） for osteoporotic vertebral compression fracture. Methods：From June 2009 to December 2011,63 patients with osteoporotic vertebral compres- sion fracture underwent PKP,there were 18 males and 45 females with an average age of 75.3 years （ ranged,62 to 91 ）. All patients with severe back pain and without neurological symptoms and signs ,which were confirmed by X-ray and MRI. Among them, there were 63 cases with severe osteoporosis, 37 cases with hypertension, 10 with coronary artery disease, 29 with anemi- a, 26 with diabetes, 11 with chronic obstructive pulmonary diseases and 8 with gastritis and peptic ulcer. The common periop- erative complications were retrospectively reviewed. Results：Preoperative complications oceured in 9 cases （14.3%）, including hypostatic pneumonia （1 case）, electrolyte disturbances （2 cases）, urinary tract infection （2 cases）, moderate anemia （2 cas- es） ,electrolyte disturbances combined with moderate anemia （1 case）,hypostatic pneumonia combined with delirium （1 case）. Intraoperative and postoperative, complications occurred in 17 cases （26.9%）,there were bone cement correlated com- plications in 9 cases （14.3%）,in which 2 cases of toxic reaction of bone cement and 7 cases of leakage （2 cases had clinical symptoms） ; there were non-bone cement correlated complications in 3 cases （4.8%） ,in which 1 case of focal hematoma caused by paracentesis, 1 case of transient nerve injury, 1 case of left intercostal neuralgia;there were transient hyperpathia in 5 cases after operation. All complications result in no severe consequence after treatment. Conclusioa：Perioperative complications of pereutaneous kyphoplasty are not uncommon,however, these complications may not cause serious consequence after active treatment, so prevention and treatment are important for it.