椎体骨质疏松性骨折经皮椎体成形术并发症发生原因及预防措施

Causes and preventive measures of complications of percutaneous vertebroplasty for osteoporotic vertebral fractures

目的:探讨经皮椎体成形术(PVP)及经皮椎体后凸成形术(PKP)治疗椎体骨质疏松性压缩性骨折并发症的发生原因及预防措施。方法:收治椎体骨质疏松性压缩性胸椎和腰椎骨折患者645例,行PVP或PKP术,探讨并发症发生原因及预防措施。结果:645例患者中,疼痛完全消失621例,术后轻度疼痛20例,疼痛症状好转不明显4例。并发症发生情况,骨水泥向外渗漏185例,节段穿刺错误2例,术中出现一过性缺血、缺氧表现15例,腰椎穿刺部位出现血肿3例,术后出现一过性头痛5例,椎体后凸成形术椎体再骨折13例,邻近椎体骨折47例。治疗满意638例,治疗不满意7例。结论:严格掌握手术适应证、手术操作技术的提高、术后积极功能锻炼及严格、正规抗骨质疏松治疗是预防并发症发生的关键措施。

Objective:To explore the causes and preventive measures of complications of percutaneous vertebroplasty(PVP) and percutaneous kyphoplasty(PKP) in the treatment of osteoporotic vertebral fractures.Methods:645 patients with osteoporotic vertebral compression fractures of thoracic and lumbar vertebrae were selected.They were treated with PVP or PKP.We explored the causes of complications and preventive measures.Results:In 645 patients,the pain disappeared completely in 621 cases;20cases had mild pain after operation;4 cases had no improvement in pain symptoms.Complications:there were 185 cases of bone cement leakage,2 cases of error segmental puncture,15 cases of transient ischemia and hypoxia at operation,3 cases of lumbar puncture site hematoma,5 cases of transient headache after operation,13 cases of vertebral fracture of vertebroplasty(kyphoplasty),47 cases of adjacent vertebral fracture,the treatment was satisfactory in 638 cases,and the treatment was not satisfactory in 7 cases.Conclusion:They were the key measures to prevent complications by strictly mastering the indications of operation,skilled operation technique,active functional exercise after operation and strict and standard anti osteoporosis therapy.