经皮椎体成形术后椎管内骨水泥渗漏的回顾性研究

The intraspinal bone cement leakage after percutaneous vertebroplasty and laminectomy:a retrospective study

[目的]回顾性分析经皮椎体成形术后椎管内骨水泥渗漏与椎体骨折类型之间的关系,观察后路椎板减压骨水泥清除术后脊髓神经功能的恢复情况。〔方法」对2010年9月~2014年7月间发生的椎管内骨水泥渗漏患者共60例进行研究,其中有脊髓压迫症状32例,无症状28例。统计分析椎管内骨水泥渗漏与胸腰椎骨折类型之间的关系。对有脊髓压迫症状的患者,全部行后路椎板减压骨水泥清除术,术后定期随访（随访时间5~35个月,平均14个月）。采用ASIA 2000脊髓损伤神经功能评定标准,分析比较术前和末次随访时脊髓神经功能恢复情况。[结果]外伤性椎体骨折发生椎管内骨水泥渗漏率比骨质疏松骨折要高（P〈0.05）,其他类型骨折骨水泥渗漏率之间比较差异均无统计学意义（P〉0.05）。影像学分析提示骨水泥主要通过椎体皮质破损渗漏入椎管,部分通过椎体后静脉丛渗漏入椎管。32例脊髓神经损伤患者行椎板减压骨水泥清除术后神经功能有恢复24例,无恢复8例,总体恢复率75%。[结论]外伤性椎体骨折行经皮椎体成形术发生椎管内骨水泥渗漏概率较高,术前评估椎体后壁的完整性,对于预防骨水泥渗漏有参考价值;对于有神经症状的椎管内骨水泥渗漏患者,后路椎板减压骨水泥清除术是一种有效的治疗方法。

[Objective]To retrospectively investigate the relationship between bone cement leakage and vertebral fracture types,and the effect of spinal cord recovery after laminectomy and bone cement removal surgery.[Method]Sixty patients with intraspinal bone cement leakage were treated in our hospital from September 2010 to July 2014 including 32 cases of spinal nerve compression symptoms 28 cases of asymptomatic.Statistical analysis was made to find the relationship between bone cement leakage and the type of thoracolumbar fractures.All patients with nerve root compression symptoms underwent surgery of laminectomy and bone cement removal.All patients were followed for an average time of 14 months（range,5 to 35 months）.Based on International Standards for Neurological Classification of Spinal Cord Injury（ASIA2000）,the grade of functionally neurologic recovery before operation and at final follow- up were assessed and compared.[Result]The occurrence rate of bone cement leakage in traumatic fractures was higher than that in osteoporosis fracture（P 0.05） /comparison between other types of fractures showed no statistical difference（P 0.05） on the rate of bone cement leakage.Imaging observation showed that the bone cement was leaked into the spinal canal through damaged vertebral cortex primarily,while partly by vertebral venous plexus.In 32 cases with spinal nerve compression symptoms after laminectomy,the neural function recovered in 24 cases,wherea no recovery was achieved in another 8 cases,the total recovery rate was 75%.[Conclusion]The occurrence rate of bone cement leakage in traumatic compression fractures after percutaneous vertebroplasty is higher than other fracture types.The evaluation of the integrity of the posterior wall of vertebral body before the operation has a reference value to prevent leakage of bone cement.For patients having neurological symptoms with intraspinal bone cement leakage,the laminectomy and bone cement removal surgery is a kind of effective treatment method.