经皮椎体后凸成形术椎管内骨水泥渗漏的诊断及预防

The diagnosis and prevention of the cement leakage in the spinal canal after percutaneous kyphoplasty

目的探讨经皮椎体后凸成形术(PKP)椎管内骨水泥渗漏的诊断及预防。方法从PKP治疗并术后行CT复查的146例骨质疏松性椎体骨折患者(189椎)中筛选出有椎管内骨水泥渗漏的患者。按渗漏形状分为颗粒型、片状型、团块型。按渗漏路径的不同分为两型,B型为沿椎基底静脉孔渗漏到椎体后缘,C型为沿椎体骨皮质破损处渗漏至椎管。结果术后CT证实有38例(39椎)发生椎管内骨水泥渗漏,其中颗粒型19椎,片状型18椎,团块型2椎。B型20椎,C型19椎。X线明确诊断的仅11椎,准确率28.2%;CT明确诊断39椎,准确率100%。患者疼痛VAS评分术后第3天为0~4(2.0±1.4)分,与术前5.8~8.5(7.0±1.2)分比较差异有统计学意义(P<0.05)。患者随访3~10个月,无神经损伤症状与体征。结论椎管内骨水泥渗漏准确的诊断方法是CT检查,X线检查易漏诊。控制骨水泥注入量、注入速度、注射时机及控制骨水泥在椎体的前中部分布等措施可有效预防椎管内渗漏。

Objective To analyze the causes,diagnosis and prevention of bone cement leakage into the spinal canal in percutaneous kyphoplasty（ PKP）. Methods Patients with vertebral canal cement leakage were selected from 146 patients with osteoporotic vertebral fracture（ 189 vertebral bodies） underwent CT reexamination after PKP. Diagnosis was analyzed,and particles were divided into particle type,flake type and mass type according to the shape of the leakage. According to different leakage path,it was divided into two types. Type B referred to leakage from vertebral basilar vein hole to the posterior edge of the vertebral body,and type C for the leakage from where the vertebral body was damaged to the spinal canal. Results Postoperative CT confirmed that there were 38 cases（ 39 vertebral bodies） of cement leakage of spinal canal,among them,particle type had 19 vertebral bodies,flake type 18 and mass type 2. Type B had 20 vertebral bodies,while type C had 19 vertebral bodies. Only 11 vertebral radiographs of X-ray could be clear diagnosed,the accuracy rate was 28. 2%,and the accuracy rate of CT was 100%. VAS of patients with pain on the third day after surgery was 0 - 4（ 2. 0 ± 1. 4） points,compared with the preoperative of 5. 8 -8. 5（ 7. 0 ± 1. 2） score,and the difference was statistically significant（ P〈0.05）. Patients were followed up for 3 -10 months,no neurological injury symptoms and signs happend. Conclusions The accurate diagnosis method of cement leakage in spinal canal is CT,and missed diagnosis is easier to happen by X-ray. The effective method of reducing the cement leakage in the spinal canal is to control the volume of bone cement injection,injection rate and injection timing,as well as taking control of bone cement distribution in the anterior vertebral body.