胸腰椎骨折椎体强化术中骨水泥渗漏率分析

Retrospective analysis of the incidence of bone cement leakage after percutaneous vertebroplasty

目的分析胸腰椎骨折行经皮椎体成形术（PVP）或经皮椎体后凸成形术（PKP）骨水泥渗漏率。方法对550例骨质疏松性胸腰椎体压缩性骨折（650椎）、爆裂性骨折（61椎）患者施行PVP（201椎）或PKP（510椎）。术后对责任椎常规复查X线片。结果骨水泥渗漏共135椎（18.99%）,其中PVP 72椎（10.12%）,PKP 63椎（8.86%）。患者均获得随访,时间3-24个月。渗漏类型：椎体周缘型75椎（10.55%）,椎间隙型25椎（3.52%）,椎管型16椎（2.25%）,针道型10椎（1.41%）,椎间静脉型9椎（1.26%）,无椎间孔渗漏。以L145椎为最多（33.33%）。有3例患者出现胸闷,吸氧后缓解;其余患者均无明显临床症状。所有患者术后疼痛明显减轻。结论虽然椎体强化术术中骨水泥渗漏率较高,但椎管内及椎间孔渗漏率较低,因此渗漏产生明显临床症状者较少。

Objective To analyze the incidence rate of bone cement leakage in thoracolumbar fractures treated with percutaneous vertebroplasty（ PVP） or percutaneous kyplasty（ PKP）. Methods A total of 550 patients were enrolled,who had 650 thoracolumbar osteoporotic compression fractures and 61 critical crack fractures and received PVP（ 201 vertebraes） or PKP（ 510 vertebraes）. Every patient received X-ray examination postoperatively. Results Statistics showed that 135 vertebraes（ 18. 99%） had bone cement leakage,including 72 vertebraes（ 10. 12%） after PVP and 63 vertebraes（ 8. 86%） after PKP. All patients were followed up in period of 3 - 24 months,all patients＇ pain had obviously relief by VAS after the operation. There were 6 types of leakage： 75 vertebraes（ 10. 55%） presented perivertebral leakage,25 vertebraes（ 3. 52%） presented intervertebral leakage,16 vertebraes（ 2. 25%） presented the leakage of the spinal canal,10 vertebraes（ 1. 41%） presented bone cement into the needle channel,9 vertebraes（ 1. 26%） had the leakage of the intervertebral vein,none of them presented foramen leakage. The complications of bone cement leakage happened with 45 vertebras L1 for the most（ 33. 33%）. Three patients slightly had the respiratory distress and relieved by oxygen inhalation. Other patients didn＇t have obvious discomfort. Conclusions The rate of bone cement leakage is considerably big. The leakage in the canalis spinalis is small. But few patients have obvious clinical symptoms.