椎体成形术治疗脊柱肿瘤术后并发截瘫1例及相关文献复习

Percutaneous Vertebroplasty for the Treatment of One Case of Spinal Tumors with Paraplegia:and Review of Related Literature

目的:探讨经皮穿刺椎体成形术治疗脊柱肿瘤术后并发瘫痪的原因及降低手术并发瘫痪的预防措施。方法:回顾性分析江西中医药大学附属医院诊治的1例脊柱肿瘤椎体成形术后并发瘫痪患者的病例资料。患者万某,女,56岁,入院时腰背部及胁肋部疼痛剧烈,VAS评分7分,第一次行经皮穿刺椎体成形术并活检取出术,术后患者出现剑突水平以下截瘫,MRI显示T8-9椎体水平脊髓受压,T2加权像显示致压物质呈中等高信号、T1加权像呈低信号。CT显示无骨水泥渗漏至椎管。第二次行开放手术,术中见4 cm×3 cm大小灰白色肿瘤组织侵占椎管并送检。结果:第一次行椎体成形术,骨水泥未渗漏至椎管,术后患者出现截瘫症状,第二次行开放手术解除椎管压迫,术中见肿瘤组织侵入椎管压迫脊髓,术后ASIA评级C级,病理组织学检查提示弥漫性大B细胞淋巴瘤。结论:经皮穿刺椎体成形术用于脊柱肿瘤治疗并发瘫痪的发生率极低,除穿刺失败、骨水泥渗漏至椎管及血管栓塞等因素外,需警惕在骨水泥注入过程中有肿瘤组织向后移位压迫脊髓的可能,一旦发生,需积极处理,预后差。

Objective:To explore the possible causes of paralysis after spinal tumors treated by percutaneous vertebroplasty and preventive measures to reduce the paralysis after surgery.Methods:Review the literature on percutaneous vertebroplasty for the treatment of spinal tumors with paralysis,and retrospectively analyze the medical records of a patient with paralysis after spinal tumors with vertebroplasty in our hospital.A 56-year-old female patient suffered from severe pain in the lower back and flank at the time of admission.The VAS score was 7 points.The patient underwent percutaneous vertebroplasty and biopsy for the first time.The patient developed paraplegia below the xiphoid level after surgery.MRI showed T8 The spinal cord is compressed at the level of-9 vertebral body.The T2-weighted image shows a medium-high signal for the pressure-producing substance,and the T1-weighted image shows a low signal.CT showed no bone cement leaked into the spinal canal.Open surgery was performed for the second time.During operation,4cm*3cm gray-white tumor tissue invaded the spinal canal and was sent for examination.Results:In the literature,7 patients with paralysis after spinal tumor surgery were reported by vertebroplasty,including 2 cases of puncture,2 cases of tumor tissue were displaced backward during the bone cement injection,and 5 cases of bone cement leakage,including 1 One case leaked into the spinal canal,2 cases leaked into the blood vessel,and 2 cases leaked secondary to the puncture hole.The main reason for the paralysis of the patients reported in this article is that bone cement squeezes the tumor tissue to the spinal canal and causes spinal cord injury.After opening,ASIA rating:C grade.Postoperative histopathological examination revealed diffuse large B-cell lymphoma.Conclusion:The incidence of percutaneous vertebroplasty for spinal tumors with paralysis is extremely low.In addition to the failure of puncture,leakage of bone cement into the spinal canal and vascular embolism,we must be alert to tumor tissue during the injection of bone cement The possibility of backward compression of the spinal cord needs to be actively dealt with once it occurs.