中国组织工程研究 ›› 2018, Vol. 22 ›› Issue (26): 4241-4246.doi: 10.3969/j.issn.2095-4344.0780

• 生物材料综述 biomaterial review • 上一篇    下一篇

经皮椎体成形骨水泥渗漏的治疗与预防

闫光华,葛顺杰,仇继任,陆茂德   

  1. 广西钦州市第二人民医院骨二科,广西壮族自治区钦州市 535000
  • 收稿日期:2018-01-04
  • 作者简介:闫光华,男,1983年生,山西省运城市人,汉族,2010年广西医科大学毕业,硕士,主治医师,主要从事脊柱外科研究。

Prevention and treatment of cement leakage in percutaneous vertebroplasty

Yan Guang-hua, Ge Shun-jie, Qiu Ji-ren, Lu Mao-de   

  1. Department of Orthopedics, Second People’s Hospital of Qinzhou, Qinzhou 535000, Guangxi Zhuang Autonomous Region, China
  • Received:2018-01-04
  • About author:Yan Guang-hua, Master, Attending physician, Department of Orthopedics, Second People’s Hospital of Qinzhou, Qinzhou 535000, Guangxi Zhuang Autonomous Region, China

摘要:

文章快速阅读:

 

文题释义:
经皮椎体成形:椎体成形术作为一种开放手术用于增强椎弓根螺钉和充填肿瘤切除后遗留的缺损已有几十年的历史,该手术是将骨组织或骨水泥注入椎体,从力学上增强其结构强度。对于某些病例,由于开放手术的风险太大,而使医患双方止步,因此出现了经皮椎体成形。经皮椎体成形继承了椎体成形的优点而无与开放手术有关的并发症。
骨水泥渗漏:是椎体成形最常见的并发症,多数情况下,骨水泥渗漏不会引起明显症状,多无需特殊处理。但是,一旦骨水泥渗漏到硬膜外或椎旁静脉则可能引起神经损伤、肺栓塞等灾难性后果,神经损伤多经保守治疗可缓解,如未能缓解甚至进行性加重,则应及时开放减压,肺栓塞则需抗凝、溶栓等治疗,必要时甚至切开取栓。
 
 
背景:经皮椎体成形具有手术创伤小、止痛效果好等特点,且可增加椎体强度、稳定椎体,目前已被广泛应用于临床,但其手术并发症骨水泥渗漏发生率较高。
目的:归纳总结经皮椎体成形骨水泥渗漏的治疗与预防。
方法:应用计算机检索PubMed数据1999年1月至2017年6月发表的文献,检索词为“Percutaneous Vertebroplasty;Bone Cement Leakage;Prevention and Treatment”;检索中国知网2006年5月至2017年7月发表的文献,检索词为“经皮椎体成形术;骨水泥渗漏;预防及治疗”。

结果与结论:为减少骨水泥渗漏的发生,应注意以下几项:术前详细查体并询问病史,完善影像学检查,严格掌握手术适应证及禁忌证;术中选择合适的穿刺路径、全程C臂透视并与患者充分交流;尽可能使用高黏度的骨水泥,并在面团期注入适量骨水泥;骨水泥灌注结束后静置数分钟后再拔针。大部分骨水泥渗漏无临床症状,有的仅表现为局部疼痛,保守对症治疗后多能恢复。对于一些灾难性后果,如骨水泥椎间孔渗漏压迫脊髓及神经,保守治疗不能彻底解除其压迫,必要时开放手术取出骨水泥。对于肺栓塞及下肢静脉栓塞等严重并发症,如症状不能缓解,则需手术取栓。

ORCID: 0000-0001-9221-0352(闫光华)

 

关键词: 骨水泥渗漏, 生物材料, 骨科材料, 经皮椎体成形, 预防及治疗

Abstract:

BACKGROUND: Percutaneous vertebroplasty is characterized by small surgical trauma and good analgesic effect, and it can also increase the strength and stability of the vertebral body. Therefore, it has been widely used in clinical practice. However, postoperative bone cement leakage is still at high incidence.

OBJECTIVE: To summarize the prevention and treatment of cement leakage in percutaneous vertebroplasty.
METHODS: We retrieved PubMed for relevant articles published from January 1999 to June 2017. The key words were “percutaneous vertebroplasty; bone cement leakage; prevention and treatment”. We also retrieved CNKI database for relevant articles published from May 2006 to July 2017, with the key words of “percutaneous vertebroplasty; bone cement leakage; prevention and treatment” in Chinese.

RESULTS AND CONCLUSION: In order to reduce the occurrence of the leakage of bone cement, there are some cautions as follows: (1) perform a detailed preoperative examination and inquire the medical history; (2) perfect imaging examination;       (3) master the surgical indications and contraindications strictly; (4) choose the proper puncture path, and use C-arm perspective and communicate with patients during the operation; (5) use high-viscosity bone cement as much as possible, inject proper amount of bone cement in the dough consistency; and (6) pull the needle until a few minutes after the completion of the bone cement infusion. Cement leakage is asymptomatic in most cases, and some patients only feel local pain. Most patients can recur after the conservative treatment. Some catastrophic consequences, such as bone cement leakage via intervertebral pores, appear with the compression of the spinal cord and nerve, and conservative treatment cannot completely remove the compression. We should remove bone cement by open surgery if necessary. For serious complications such as pulmonary embolism and lower limb vein embolism, surgical treatments should be taken in the presence of unrelieved symptoms.

中国组织工程研究杂志出版内容重点:生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程

Key words: Vertebroplasty, Intraoperative Complications, Tissue Engineering

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