中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (8): 1515-1518.doi: 10.3969/j.issn.1673-8225.2011.08.045

• 生物材料临床实践 clinical practice of biomaterials • 上一篇    

经皮椎体成形102例中22例骨水泥渗漏原因

彭小忠，陈  明，武振国，杨智贤，韦涵渝，雷成刚，黄站珠，朱成明   

  1. 柳州市工人医院脊柱外科，广西壮族自治区柳州市  545005
  • 收稿日期:2010-08-10 修回日期:2010-10-23 出版日期:2011-02-19 发布日期:2011-02-19
  • 通讯作者: 陈明，博士，主治医师，柳州市工人医院脊柱外科，广西壮族自治区柳州市 545005
  • 作者简介:彭小忠，男，1968年生，广西壮族自治区资源县人，苗族，1993年广西医科大学毕业，副主任医师，主要从事脊柱外科专业。nxcnn@163.com

Analysis of bone cement leakage in the percutaneous vertebroplasty in 22 of 102 cases

Peng Xiao-zhong, Chen Ming, Wu Zhen-guo, Yang Zhi-xian, Wei Han-yu, Lei Cheng-gang, Huang Zhan-zhu, Zhu Cheng-ming   

  1. Department of Spinal Surgery, Liuzhou Worker’s Hospital, Liuzhou  545005, Guangxi Zhuang Autonomous Region, China
  • Received:2010-08-10 Revised:2010-10-23 Online:2011-02-19 Published:2011-02-19
  • Contact: Chen Ming, Doctor, Attending physician, Department of Spinal Surgery, Liuzhou Worker’s Hospital, Liuzhou 545005, Guangxi Zhuang Autonomous Region, China
  • About author:Peng Xiao-zhong, Associate chief physician, Department of Spinal Surgery, Liuzhou Worker’s Hospital, Liuzhou 545005, Guangxi Zhuang Autonomous Region, China nxcnn@163.com

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517

被引次数

48

摘要：

背景：骨水泥自身具有一定流动性性状导致经皮椎体成形治疗中出现渗漏比例较高，如何在临床工作中尽量减少骨水泥渗漏概率，预防严重并发症的发生，是学者们关注的热点问题。
目的：回顾经皮椎体成形治疗骨质疏松性椎体压缩骨折后的骨水泥渗漏情况，总结骨水泥渗漏的防治措施。
方法：经皮椎体成形治疗骨质疏松性椎体压缩骨折102例131个椎体，在X射线机透视下定位伤椎，经单侧椎弓根至椎体前中1/3处注入骨水泥，至填充、弥散满意后3~5 min，拔出穿刺针。观察患者疼痛缓解程度及骨水泥渗漏情况。
结果与结论：90例疼痛完全消失，8例疼痛明显减轻，4例疼痛减轻，无疼痛加重患者。术中出现骨水泥渗漏22例，其中3例渗漏于椎管内，无急性脊髓压迫症状；5例渗漏至前纵韧带下及周围，无明显大血管侵蚀症状；4例渗漏至神经根管周围，出现单侧神经根刺激性症状，出现单侧下肢放射性疼痛，给予脱水、地塞米松以及神经营养，卧床休养治疗后缓解。渗漏至椎体外周6例，无明显临床症状；明显肺内散在点状骨水泥渗漏1例，无明显呼吸症状；3例沿椎旁静脉扩散至上及下位椎体周围，无明显神经症状。聚甲基丙烯酸骨水泥留置体内未发生排斥反应。结果显示经皮椎体成形治疗骨质疏松性椎体压缩骨折效果良好，但是骨水泥渗漏发生率较高，需严格掌握手术适应证，减少骨水泥渗漏的发生。

关键词: 骨水泥, 经皮椎体成形术, 骨质疏松, 压缩性骨折, 渗漏

Abstract:

BACKGROUND: Bone cement has some traits of liquidity due to a higher proportion of leakage in the treatment of percutaneous vertebroplasty (PVP). How to minimize the probability of bone cement leakage in clinical work and prevent serious complications are hot issues of concern to scholars.
OBJECTIVE: To review bone cement leakage after percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture, and to summarize prevention and cure measures of bone cement leakage.
METHODS: Osteoporosis vertebral compression fractures in 131 centrums of 102 cases were treated with PVP. Injured centrum was located under the X-ray machine perspective, through the unilateral pedicle of vertebral arch to centrum 1/3 of before and middle was injected with bone cement to fill, diffusion satisfaction 3-5 minutes, the transfixion pin was pulled out. The degree of pain relief and bone cement leakage in patients were observed.
RESULTS AND CONCLUSION: A total of 90 cases with the pain completely disappeared, 8 cases with the pain significantly reduced, 4 cases with the pain reduced, without patients with exacerbation of pain. A total of 22 cases with bone cement leakage in surgery, including 3 cases of leakage in the spinal canal, without symptoms of acute spinal cord compression. 5 cases exhibited leakage under and around the anterior longitudinal ligament, without significant symptoms of major vascular erosion. 4 cases exhibit leakage around the nerve root canal, with irritative symptoms of unilateral nerve root and radioactive pain of unilateral lower limb. Patients were treated with dehydration, dexamethasone, and nerve nutrition, and then were relieved after the treatment of bed rest. 6 cases of leakage to peripheral vertebral, there was no neurological symptom. 1 case showed pulmonary punctate cement leakage, with no significant respiratory symptoms. 3 cases of leakage along the paravertebral vein spread from around the first and lower vertebral, there was no neurological symptom. There was no rejection in polymethacrylic acid bone cement in vivo. The results showed that PVP treatment of osteoporosis vertebral compression fractures has good effect, but with a higher incidences of cement leakage, surgical indications are need to be strictly controlled to reduce the incidences of bone cement leakage.

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