经皮椎体成形术治疗骨质疏松性椎体压缩性骨折并发症原因分析及预防

目的：分析经皮椎体成形术（percutaneous vertebroplasty,PVP）治疗骨质疏松性胸腰椎压缩性骨折并发症的原因,并提出防治措施。方法：自2004年5月至2008年6月,采用C形臂X线机透视下经皮椎体成形术204例（286个椎体）,发生并发症56例,其中男18例,女38例;年龄58～93岁,平均72岁。观察其骨水泥渗漏和并发症发生情况。结果：与骨水泥渗漏相关的并发症49例,60个椎体,其中渗漏到椎管内5例,渗漏到神经根管3例,渗漏到椎旁软组织20例,渗漏到相邻椎间盘15例,渗漏到椎旁静脉丛6例。与骨水泥渗漏无关的并发症7例,其中穿刺损伤神经根3例,一过性疼痛加剧2例,一过性血压降低2例。结论：导致并发症发生的主要原因有穿刺椎体的骨皮质不完整,骨水泥本身的毒性,操作技术不规范,不能准确掌握骨水泥注入时机和注入量,术中C形臂X线机透视监测不充分等。预防措施主要有：严格掌握PVP的手术适应证,规范手术操作,术中充分的X线透视监测,准确掌握骨水泥注入时机和注入量,术中心电监护。

Analysis of the complication and prevention on treatment of osteoporotic vertebral compressive fractures by percutaneous vertebroplasty(PVP)

Objective: To analyze the reasons of the complications,and the measures taken for the prevention and treatment by percutaneous vertebroplasty(PVP) for osteoporotic thoracolumbars vertebral compressive fractures. Methods: From May 2004 to June 2008,204 patients with 286 diseased vertebrae underwent PVP under the guidance of C-arm fluoroscopy,and 56 patients with complications included 18 males,38 females ,ranging in age from 58 to 93 years,with an average of 72 years. The condition of leakage of bone cement and complications was observed. Results: The complications related to the leakage of PMMA found in 60 vertebrae in 49 cases:vertebral canal in 5 cases,intervertebral foramina in 3 cases,soft tissue besides vertebrae in 20 cases,intervertebral discs in 15 cases,venous plexus besides vertebrae in 6 cases. The complications no related to the leakage of PMMA found in 7 cases:the nerve roots injuried in 3 cases;the pain of the patient worsened temporarily in 2 cases;the blood pressure of the patient descent temporarily in 2 cases. Conclusion: The main reasons of complications are no-integrated of the compressived vertebrae,unstandard skills of injecting,unsuitable opportunity and quantity of injecting PMMA,unsufficient monitoring of C-arm fluoroscopy,the toxicity of PMMA.The measures of prevention and treatment is strict indication,standard skills of injecting,sufficient monitoring of C-arm fluoroscopy,suitable opportunity and quantity of injecting PMMA,electrocardio-monitoring in operation.