经皮椎体成形术穿刺失误致并发症的治疗

Treatment of the complications of percutaneous vertebroplasty caused by puncture lapsus

目的探讨骨质疏松性椎体压缩性骨折行经皮椎体成形术（percutaneous vertebroplasty，PVP）时穿刺失误所致并发症的治疗方法。方法回顾性分析2011年12月至2014年11月收治3位骨质疏松性椎体压缩性骨折PVP术后出现并发症行翻修手术患者的病历资料，均为女性，年龄71-82岁，平均78岁。1例患者因“骨质疏松性T12椎体压缩性骨折”，PVP术后出现椎管内骨水泥外漏致左侧腹部束带感、左腹股沟区痛触觉减退，1年后行“前路减压、骨水泥取出及内固定术”。1例患者因“骨质疏松性L1椎体压缩性骨折”，PVP术后出现椎管内骨水泥外漏致腹部及双下肢疼痛、双下肢肌力下降以及痛、触觉减退，再次行“后路减压、骨水泥取出及内固定术”。1例患者因“骨质疏松性T12椎体压缩性骨折”，PVP术后出现椎管内血肿致两下肢肌力0级，感觉障碍，再次行“后路椎板减压、椎管内止血及血肿清除术”。再次术后随访21～29个月，平均24．7个月，观察患者恢复情况，并分析出现并发症的原因。结果1例患者翻修术后腹部束带感消除，左侧腹股沟区痛、触觉改善，随访21个月内固定无松动；1例患者术后腹部及双下肢疼痛缓解，双下肢肌力恢复至4级，双下肢痛触觉恢复正常，随访29个月内固定无松动；1例患者术后双下肢肌力、感觉略恢复，同时残留双下肢疼痛，一直未完全缓解，患者在术后2年死亡。结论骨质疏松性椎体压缩性骨折行PVP术后出现脊髓受压的并发症，虽然翻修手术难度大，风险高，但只要通过合适的手术方式进行翻修可以获得良好的治疗效果。

Objective To investigate the treatment of the complications of puncture lapsus after the percutaneous vertebroplasty （PVP） for osteoporotic fractures. Methods From December 2011 to November 2014, 3 female patients with postoperative complications of PYP which were treated for osteoporotic fractures, aged from 71 to 82 years （average, 78 years old） were involved. Each of them performed a revision surgery in our hospital. One of them was performed with PVP of the 12th thoracic vertebral due to the osteoporotic thoracic vertebral compression fracture. However, bone cement was leaked into spinal canal after PVP, and the patient suffered from left abdominal constriction and impaired of sensation in left inguinal region. She underwent anterior approach of decompression, cement removal and internal fixation one year after the first operation. The second case was performed with PVP of the 1st lumbar vertebral due to the osteoporotic lumbar vertebral compression fracture. In this case, bone cement was leaked into spinal canal after PVP, and the patient suffered from abdominal and lower extremity pain, paralysis, and hypoesthesia of lower limbs. This patient was treated with posterior approach of decompression, cement removal and internal fixation. The third case was performed with the 12th thoracic vertebral PVP due to the osteoporotic thoracic vertebral compression fracture. Subdural hemorrhage happened after PVP, and the patient suffered from paralysis and sensory loss of the two lower limbs. This patient was treated with posterior approach of laminotomy, hemostasis in the spinal canal and evacuation of hematoma. We performed a follow up from 21 to 29 months （average, 24.7 months）, to observe the recovery of the patients. Results one case＇ s abdominal constric- tion eliminated and the inguinal region pain improved after the revision surgery, and there＇s no internal fixation loosening with the follow-up of 21 months. The other case＇s abdominal and lower limb pain relieved, the lower limb muscle strength recovered to grade 4, and the tactile of lower limb recovered to normal after the revision surgery. There＇ s no internal fixation loosening with the follow-up of 29 months. One case of patients with slightly recovered of lower extremity muscle strength and feeling after surgery, and remained lower limb pain, died two years after the surgery. Conclusion Complications of spinal cord compression after percutaneous vertebroplasty （PVP） for osteoporotic fractures can get good outcomes by using appropriate revision surgeries, althouzh revision surgery is difficult and risky.