经皮穿刺椎体成形术中骨水泥渗漏的原因及预防

Causes and prevention of bone cement leakage in percutaneous vertebroplasty

[目的]分析和探讨经皮穿刺椎体成形术（percutaneousvertebroplasty，PVP）治疗骨质疏松性脊柱压缩骨折骨水泥渗漏的原因及其预防措施。[方法]收集从2009年10月～2012年10月行经皮穿刺椎体成形术的患者289例（451个椎体）患者，术后行x线及CT检查，观察骨水泥渗漏情况，将所有患者分为A组（渗漏组）43例和B组（对照组）246例，根据VAS评分对患者术前、术后第1d、术后第3d及终末随访进行评分。同时根据渗漏部位的不同，进行上述评分。[结果]本研究中有43例（48个椎体）发生了骨水泥渗漏，渗漏率为11％。其中椎间隙渗漏17例，椎体周围渗漏14例，椎管内渗漏1例，椎体前缘静脉渗漏3例，针道通路渗漏8例。术后有3例局部出现酸胀不适，予中药涂擦及烫熨治疗处理后症状明显改善，余患者均无临床症状。术前、术后第3d及终末随访两组问的VAS评分无统计学意义（P〉0．05），术后第1dVAS评分在两组间有统计学意义（P〈0．05），不同时间VAS评分在不同渗漏部位问对比，均无统计学意义（P〉0．05）。[结论]椎体成形术治疗骨质疏松性脊柱压缩性骨折效果明显，骨水泥渗漏时有发生，术前常规行影像检查充分了解病椎情况，术中严格把握穿刺方法及注入时机，准确掌握骨水泥量，可以减少骨水泥渗漏的发生。

[ Objective] To analyze and evaluate the causes of bone cement leakage in patients with osteoporotic vertebral compression fracture treated with percutaneous vertebroplasty in order to develop preventive measures. [ Method] Two -hundred - eighty - nine patients （451 vertebrae） received percutaneous vertebroplasty from October 2009 to October 2012. Cement leak- age was examined through radiographs and computed tomography after the operation surgery. Patients were divided into leakage group （n = 43 ） and control group （n = 246）. VA visual analog score （VAS） score for pain was collected pre -operatively and at 1 and 3 days post - operatively, as well as at the final follow - up. These scores were also evaluated according to different areas of leakage. [ Result ] Cement leakage occurred in 43 cases （ 48 vertebrae）. The rate of leakage was 11%, including vertebra clearance leakage in 17 cases ,vertebral periphery leakage in 14 cases ,spinal canal leakage in 1 case ,3 cases of anterior verte- bral venous leakage, and 8 cases of pin tract pathway leakage. After the operation,3 patients experienced local acid bilges, which improved with traditional Chinese medicine ointment and ironing therapy. There were no clinical symptoms in the remaining pa- tients. There were no significant group differences in the VAS scores at 3 days post - operatively and at the final visit （ P 〉 0. 05 ）, but the VAS scores at 1 day post - operation were significantly different between the two groups（ P 〈 0.05 ）. For same leak- age location, the VAS scores were not significantly different between the groups at any time - point （ P 〉 0.05 ）. [ Conclusion ] Though cement leakage often occurs, percutaneous vertebroplasty is an effective way to treat osteoporotic vertebral compression fracture. Conventional imaging to fully evaluating the vertebral disease before the operation, strictly mastering the surgical method and injection time, and accurately controlling the proper amount of bone cement can reduce the occurrence of cement leakage.