经皮椎体强化术并发骨水泥渗漏的类型及其临床意义

目的探讨经皮椎体成形术（PVP）与经皮后凸成形术（PKP）并发骨水泥渗漏的类型及其临床意义。方法回顾性分析我院2001年8月至2005年3月期间收治的56例PVP和PKP患者的临床资料,按解剖位置对椎体外的局部骨水泥渗漏共分6型,PVP手术患者分为无骨水泥渗漏组、骨水泥渗漏组、椎体周围渗漏组及椎管内渗漏组,进行统计学处理,比较各组行PVP手术前后及术后各时段间疗效差异,并分析其对临床疗效的影响。结果（1）PVP手术组共43个椎体,18个椎体发生骨水泥渗漏,渗漏率42％。一处渗漏15例,其中椎体周围渗漏6例,椎管内渗漏5例,椎问孔内渗漏2例,椎间盘内渗漏1例,椎旁软组织内渗漏1例;发生两处渗漏3例。（2）PKP手术组共22个椎体,4个椎体发生骨水泥渗漏,渗漏率18％。4例均为一处骨水泥渗漏,其中椎体周围渗漏2例,椎管内渗漏1例,椎间孔内渗漏1例。5例渗漏患者出现新症状：腹膜刺激征和神经损伤症状,3例经保守治疗有效,2例需要手术减压。结论经皮椎体强化术（包括PVP和PKP）并发骨水泥渗漏以椎体周围型和椎管内型常见;少数患者可出现腹膜刺激征和神经损伤症状。除椎管内渗漏组早期疗效受影响外,其余各组骨水泥渗漏不影响手术效果。

The classification and its clinical value for extravertebral cement leakage complicated by percutaneous vertebral augmentation

Objective To explore the category and its clinical value of extravertebral cement leakage complicated by percutaneous vertebroplasty and kyphoplasty. Methods After collecting clinical data of 56 patients underwent surgery of PYP or PKP between August 2001 and March 2005, extravertebral cement leakage was classified according to anatomical position, and its clinical value was analysed. Results Eighteen vertebraes presented cement leakage in all 43 vertebraes in PVP group. There were 15 vertebraes with one-place leakage, 6 vertebraes with perivertebral leakage, 5 spinal canal leakage, 2 intraforaminal leakage, 1 intradical leakage and 1 paravertebral soft tissues leakage respectively among them; and there were 3 vertebraes with two-place leakage. Four vertebraes presented cement leakage in all 22 vertebraes in PKP group. All 4 vertebraes had one-place leakage including 2 vertebraes with perivertebral leakage, 1 spinal canal leakage and 1 intraforaminal leakage. Five patients with cement leakage presented new symptoms including peritoneal irritation signs and spinal cord or nerve root injury, 3 patients recovered after conservative treatment, whereas the other 2 patients need decompression surgery. Conclusions The types of perivertebral leakage and spinal canal leakage are common among extravertebral cement leakage followed by pereutaneous vertebroplasty and kyphoplasty. The minority of patients with cement leakage presents new symptoms, and the majority of them has the same therapic effect except patients with spinal canal leakage on one day after surgery.