摘要
目的回顾性观察经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性压缩骨折(osteoporotic vertebral compression fracture,OVCF)发生骨水泥渗漏的影像学特点,探讨PKP治疗OVCF并发骨水泥渗漏对临床疗效的影响。方法 2011年5月~2014年6月行PKP的OVCF患者共278例286个椎体,均行术中C型臂监测、术后X线片及CT检查以明确是否存在骨水泥渗漏,以及骨水泥渗漏的分型。发生骨水泥渗漏的96例102椎作为A组,男性28例,女性68例;年龄47~85岁,平均65.8岁;未发生骨水泥渗漏的182例184椎作为B组,男性48例,女性134例;年龄45~86岁,平均67.3岁。统计学分析比较两组术后椎体高度恢复、Cobb角变化,以及术前、术后、随访时腰背部疼痛视觉模拟评分(visual analogue scale,VAS)。结果 A组渗漏入椎管内28椎占27.5%,其中通过椎基静脉孔渗漏为26椎占25.5%,通过破裂的椎弓根渗漏入椎管2例占2.0%;渗漏入椎间隙内32例占31.4%;渗漏入其他部位(椎体侧方前方、椎旁静脉以及经针道渗漏)42例占41.1%。A组骨水泥注入量大于B组,有统计学意义(P<0.05),两组术后椎体高度恢复、Cobb角变化以及术前、术后、随访时VAS无统计学差异(P>0.05)。结论 PKP常发生骨水泥渗漏,可能与注入骨水泥量过多有关;椎基静脉孔和椎体上终板是骨水泥渗漏的主要部位;骨水泥渗漏与椎体高度、Cobb角及患者疼痛缓解关系不明显。
Objective To retrospectively observe the characteristics of PMMA leakage in percutaneous kyphoplasty(PKP) for treating osteoporotic vertebral compression fracture(OVCF),and to discuss its influence on the clinical effects.Methods From May 2011 to Jun.2014,286 vertebras of 278 OVCF patients were conducted by PKP in our spinal surgery department.Whether there was leakage of bone cement and the type of leakage were determined by the use of intraoperative monitoring,the C arm and CT examination.96 cases(102 vertebras) of bone cement leakage were as group A,in which there were 28 males and 68 females aged 47-85 years(average 65.8years); While 182 cases(184 vertebras) without bone cement leakage were as group B,in which there were 48 males and 134 females aged 45-86 years(average 67.3 years).Statistical analysis and comparison were conducted on the height recovery,change of Cobb's angle,and the visual analogue scale(VAS) of preoperative,postoperative and follow-up between two groups.Results There were 28 vertebras accounted for 27.5% in Group A of PMMA leakage into the spinal canal,in which 26 vertebras accounted for 25.5% of leakage through basivertebral foramen,and the other 2 vertebras accounted for 2.0% had leakage through fracted pedicles.32 vertebras accounted for 31.4% had leakage into the intervertebral disc; 42 vertebras(leakage into the lateral and front side of the vertebral body,the adjacent vertebral veins and the needle channel) accounted for the other 41.1%.The cement volume of Group A was significantly more than that of Group B(P〈0.05); while the height recovery,change of Cobb's angle,and the VAS of preoperative,postoperative and follow-up were not statistically different between the two groups(P〉0.05).Conclusion The amount of bone cement injection may account to the frequent occurrence of cement leakage.The basivertebral foramen and superior endplate are the main part of the bone cement leakage.The relationship between the leakage of bone cement amount and vertebral body height,Cobb's angle and the patients' pain relief is not obvious.
出处
《创伤外科杂志》
2017年第4期287-290,共4页
Journal of Traumatic Surgery
关键词
骨质疏松性压缩骨折
经皮椎体后凸成形术
骨水泥
渗漏
并发症
osteoporotic vertebral compression fracture(OVCF)
percutaneous kyphoplasty(PKP)
bone cement
leakage
complications