中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (30): 5669-5674.doi: 10.3969/j.issn.1673-8225.2011.30.039

• 骨与关节临床实践 clinical practice of the bone and joint • 上一篇    下一篇

椎体成形穿刺注射骨水泥防止灾难性并发症：87例137个椎体资料分析

黄卫国，易军飞，白瑞飞，刘友军，陈  通   

  1. 柳州市柳铁中心医院骨科，广西壮族自治区柳州市   545007
  • 收稿日期:2011-04-13 修回日期:2011-06-08 出版日期:2011-07-23 发布日期:2011-07-23
  • 作者简介:黄卫国☆，男，1966年生，广西壮族自治区天等县人，壮族，2007年中山大学第二附属医院毕业，博士，副主任医师，主要从事脊柱外科研究。 hwglylg@163.com

Vertebroplasty with bone cement injection to prevent catastrophic complications: Clinical analysis of 87 patients with 137 vertebrae

Huang Wei-Guo, Yi Jun-fei, Bai Rui-fei, Liu You-jun, Chen Tong   

  1. Department of Orthopaedics, Liutie Central Hospital of Liuzhou City, Liuzhou  545007, Guangxi Zhuang Autonomous Region, China
  • Received:2011-04-13 Revised:2011-06-08 Online:2011-07-23 Published:2011-07-23
  • About author:Huang Wei-guo☆, Doctor, Associate chief physician, Department of Orthopaedics, Liutie Central Hospital of Liuzhou City, Liuzhou 545007, Guangxi Zhuang Autonomous Region, China hwglylg@163.com

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摘要：

背景：椎体成形治疗老年骨质疏松椎体压缩性骨折效果确切，但一些热点问题仍无定论。
目的：探讨椎体成形技术治疗老年骨质疏松椎体压缩性骨折过程中穿刺损伤、骨水泥注射剂量、多椎体成形及骨水泥渗漏等问题的解决方案。
方法：回顾性分析经皮穿刺椎体成形技术治疗骨质疏松椎体压缩性骨折87例137个椎体。全部经单侧椎弓根穿刺，骨水泥稀薄期注射，骨水泥注射量为3~7.5 mL，胸椎3 mL以上，腰椎4.5 mL以上，平均4.8 mL，多椎体者均一次手术完成。
结果与结论：随访6~30个月，治疗后第2天和最终随访时患者目测类比疼痛评分及Oswestry功能障碍指数评分均显著低于治疗前(P < 0.01)。所有患者胸腰背疼痛明显缓解，其中58例疼痛完全消失；1例术中出现骨水泥单体中毒症状，28例出现不同程度骨水泥渗漏，但未出现临床症状。137个椎体中骨水泥渗透达到和超过中线119个，占87.2%。提示椎体成形技术是治疗老年骨质疏松椎体压缩性骨折的有效方法。骨水泥稀薄期注射能够获得良好的渗透效果；在局麻药限量范围内，一次可完成3个以上椎体成形；严格正规的操作技术是预防骨水泥渗漏灾难性并发症最重要的方法。

关键词: 椎体成形, 骨质疏松, 压缩性骨折, 骨水泥渗漏, 并发症

Abstract:

BACKGROUND: Vertebroplasty treatment for osteoporotic vertebral compression fractures has exact effect, but some hot spots remain unclear.
OBJECTIVE: To evaluate some key technologies of vertebralplasty in the treatment of osteoporotic vertebral compression fractures such as puncture injury, bone cement injected dose, multi-vertebroplasty and bone cement leakage.
METHODS: Retrospective study of 87 patients with 137 vertebrae suffering from osteoporotic vertebral compression fractures which were treated with percutaneous vertebralplasty was performed. The patients received unilateral transpedicular puncture, bone cement injection at thin dense time and with volume from 3-7.5 mL with an average of 4.8 mL (thoracic: above 3 mL, lumbar: above 4.5 mL); all those multiple vertebral compression fracture were completed at one time.
RESULTS AND CONCLUSION: All patients were followed up for at least 6 months (6-30 months). Visual analog scale score and Oswestry disability index score were lower postoperatively (P < 0.01). All patients had complete pain relief postoperatively. One patient had the bone cement symptom of poisoning, bone cement leakage happened in 28 patients, but no severe complication occurred. The bone cement seepage reached to or surpassed the median line of vertebrae in 119 vertebrae (87.2%). Percutaneous vertebralplasty provide significant pain relief in the treatment of osteoporotic vertebral compression fracture; bone cement injected at thin dense time get satisfy seepage. The injection of over three vertebral compression fractures can be finished once. Strict and regular operative technique is the most important method to prevent catastrophic complications caused by bone cement leakage.

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