Chinese Journal of Tissue Engineering Research ›› 2013, Vol. 17 ›› Issue (47): 8275-8281.doi: 10.3969/j.issn.2095-4344.2013.47.021
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Wang Shi-jun, Yi Xiao-dong, Li Chun-de, Liu Xian-yi, Lu Hai-lin, Liu Hong, Li Hong, Yu Zheng-rong, Sun Hao-lin
Revised:
2013-08-27
Online:
2013-11-19
Published:
2013-11-19
Contact:
Yi Xiao-dong, Chief physician, Department of Orthopedics, Peking University First Hospital, Beijing 100034, China
yi_xd@263.net
About author:
Wang Shi-jun☆, M.D., Attending physician, Department of Orthopedics, Peking University First Hospital, Beijing 100034, China
doctorwang444@yahoo.com.cn
CLC Number:
Wang Shi-jun, Yi Xiao-dong, Li Chun-de, Liu Xian-yi, Lu Hai-lin, Liu Hong, Li Hong, Yu Zheng-rong, Sun Hao-lin. Relationship between paravertebral vascular leakage and pulmonary cement embolism during percutaneous vertebroplasty[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(47): 8275-8281.
2.2 参与者数量分析 纳入134例患者中共有66例具备完整的术前及术后胸部X射线资料患者,均在局麻下顺利完成手术,术中及术后均未发生严重并发症。最后随访时间1-24个月,平均11个月,无脱失。 2.3 术中椎旁血管骨水泥渗漏及骨水泥性肺栓塞发生率 在134例患者中共有23例出现骨水泥椎旁血管渗漏,占17.2%。出现椎旁血管渗漏的23例中有3例出现骨水泥性肺栓塞,占出现椎旁血管渗漏患者的13%,占全部患者的2.2%,对照组43例未出现椎旁血管渗漏的患者均未出现骨水泥性肺栓塞。由于并非全部患者均行术后胸部X射线检查,可能低估骨水泥性肺栓塞的发生率。 2.4 术中椎旁血管骨水泥渗漏与骨水泥性肺栓塞的关系 实验中存在骨水泥椎旁血管渗漏组23例,其中3例并发无症状性骨水泥性肺栓塞占出现椎旁血管渗漏患者的13%。发现肺部骨水泥栓子的患者术后均无血氧饱和度下降﹑呼吸困难﹑呼吸急促﹑紫绀﹑咳嗽﹑咯血﹑血压下降﹑心动过速﹑胸闷﹑心慌﹑胸痛﹑头晕等不适,并且在随访的过程中同样未出现肺部症状。未出现骨水泥椎旁血管渗漏组43例,均未出现骨水泥性肺栓塞,两组间比较,差异有显著性意义(P=0.039),见表1。术中出现骨水泥椎旁血管渗漏后,发生骨水泥性肺栓塞风险增加,提示术中一旦出现骨水泥椎旁血管渗漏,尽管患者并无胸部症状仍应警惕骨水泥性肺栓塞可能。 2.5 典型病例分析 女性患者,59岁。不慎摔倒致腰背部疼痛6 h入院。T12棘突叩痛(+),双下肢感觉肌力正常,术前疼痛目测类比评分7分。X射线示T12椎体压缩骨折,见图1;腰椎MRI示新鲜椎体压缩骨折,见图2,3。"
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