胸腰椎骨质疏松性骨折经皮椎体成形术后骨水泥渗漏的研究进展

Research advanced on bone cement leakage after percutaneous vertebroplasty for thoracolumbar osteoporotic fractures

骨水泥渗漏是经皮椎体成形术治疗胸腰椎骨质疏松性骨折最常见的并发症，文献报道其发生率不尽相同，最低为〈5％，最高则〉80％。骨水泥渗漏的分型较多，尚无统一的分型标准，常用的分型标准有解剖位置和渗漏途径。半定量严重程度和骨水泥粘度是骨水泥渗漏的独立高危因素。半定量严重程度越高，骨水泥粘度越低，骨水泥总体渗漏率越高。对椎间盘渗漏而言，MRI提示椎体裂隙和终板破裂亦是高危因素。绝大多数骨水泥渗漏并不引起临床症状，但可发生相邻节段椎体骨折，神经功能损伤，甚至肺栓塞和心内栓塞，甚至死亡。因此，行椎体成形术时应严格把握适应证，选择合适的填充材料，改进手术技术，尽量避免骨水泥渗漏的发生。

Bone cement leakage is the most common complication in the treatment of thoracolumbar osteoporotic fractures by percutaneous vertebroplasty. The incidence rates of the literatures are different, with the range from 5% to 80%： There are several different classifications of cement leakage; however there is no uniform classification standard. The classification criteria＇ s are based on anatomical location and leakage way. The independent risk factors of cement leakage are fracture semiquantitative severity grade and the viscosity of bone cement. The incidence rate of cement leakage increases with high fracture semiquantitative severity grade and low bone cement viscosity. For cortical leakage, the presence of c0rtical disruption and intravertebral cleft on MRI were identified as additional strong risk factors. The majority of bone cement leakage does not produce clinical symptoms. But some of the patients suffered from new adjacent osteoporotie vertebral compression fractures, neurologic deficits, pulmonary cement emboli, cardiac perforation, and even death. Therefore, we should strictly grasp the indications, select appropriate filling materials, and improve surgical techniques to avoid the occurrence of bone cement leakage.