经皮椎体成形术治疗椎体压缩骨折及椎体转移瘤的并发症对比

A comparative study of percutaneous vertebroplasty for osteoporotic vertebral compression fractures and spinal metastasis

[目的]探讨经皮椎体成形术（percutaneous vertebroplasty,PVP）治疗胸腰椎体压缩性骨折（osteoporotic vertebral compression fractures,OVCFs）与转移性肿瘤的并发症,分析发生原因及防治对策。[方法]回顾分析本院2005年7月~2014年12月行椎体成形术治疗的240例单节段胸腰椎骨折患者147例,年龄65~92岁,平均（65.4±16.5）岁;转移性肿瘤93例,年龄31~79岁,平均（51.6±14.7）岁。随访6个月~1年,平均8.8个月。记录骨折组与肿瘤组患者手术前后视觉疼痛评分（visual analogue scale,VAS）及并发症情况。[结果]240例椎体成形术患者,共发生并发症72例（30%）,其中转移性肿瘤患者41例（44%）,压缩性骨折患者31例（21%）。骨折组患者术前、术后1 d、术后1、3个月VAS评分分别为（7.36±1.28）分、（1.37±0.98）分、（2.87±0.48）分、（2.93±0.56）分。肿瘤组患者术前、术后1 d,术后1、3个月VAS评分分别为（7.86±3.35）分、（2.85±0.78）分、（2.88±3.55）分、（4.93±0.89）分。两组术前、术后1 d、术后1个月评分比较差异无统计学意义,术后3个月评分差异均有统计学意义（P〈0.05）。并发症：术中推注骨水泥时一过性血压下降6例;骨水泥渗漏30例;术后发热5例;术后自觉疼痛加重5例;1例胃癌转移性肿瘤患者术后出现昏迷,经查为高钙血症。术后3个月内邻近节段再骨折25例。[结论]对骨折和骨肿瘤应用椎体成形术治疗有一定的并发症。转移性肿瘤患者并发症发生率相对较高。总结经验,提高手术技术能有效降低并发症的发生率。

[ Objective ] To compare the complications caused by percutaneous vertebroplasty （ PVP ） for osteoporotic verte- bral compression fractures（OVCFs） and spinal metastasis, and investigate the prevention strategies. [ Method ] From July 2005 to December 2014, a total of 240 vertebrae in 240 patients（ aged from 31 to 92 years）with OVCFs （147 patients, 65 -92 years old, mean 65.4 ± 16.5 years） or spinal metastasis （93 patients,31 - 79 years old, mean 51.6 ± 14.7 years） underwent PVP. All patients were followed up for an average of 8.8 months （ range ,6 - 12 months）. The differences in pre - and postoperative visual analogue scales （VAS） and postoperative complications between OVCFs group and spinal metastasis group were compared. [ Result] Complications were noted in 72 cases in all 240 cases（ 30% ） ,with 41 cases of spinal metastasis（41/93,44% ） and 31 cases of OVCFs （31/147,21% ）. In OVCFs group, VAS before surgery, at 1 day, 1 month and 3 months after surgery were 7. 36 ± 1.28,1.37 ± 0.98, ± 2.87 ± 0.48, ± 2.93 ± 0.56, respectively. In metastasis group, the results were 7.86 ± 3.35,2.85 ± 0.78, ±2.88 ±3.55,4.93 ± 0. 89, respectively. The results of VAS in OVCFs patients were significantly better than those in spinal metastasis patients （P 〈 0.05 ）. In all patients, bone cement leakage were noted in 30 cases ,5 cases had transient hyper- tension,5 cases had postoperative fever ,5 cases had aggravation of pain,another patient was found coma after operation due to hypercaleemia. Fresh refracture was found in 25 patients in adjacent vertebrae within 3 months after operation. [ Conclusion ] The rate of complications in spinal metastasis patients is higher than that in OVCFs patients. It is important to sum up experi- ences and improve surgical technique to decrease the occurrence of complications.