椎体后凸成形术中椎管内骨水泥渗漏的探讨

目的 探讨椎体后凸成形术(PKP)中椎管内骨水泥渗漏的原因与防治方法. 方法 2002年10月至2007年12月,123例行PKP治疗的骨质疏松性椎体压缩骨折患者中,5例发生椎管内骨水泥渗漏,回顾性分析其临床资料并复习相关文献,以探寻发牛骨水泥渗漏的原因和防治方法. 结果骨水泥渗漏的原因:1例骨水泥经椎体后壁破裂处渗漏至椎管内,2例骨水泥经椎弓根内侧壁穿刺针道破裂口进入椎管,另2例骨水泥可能经椎体后部血管进入椎管内.椎管内骨水泥渗漏发生部位:T121例,L12例,L31例,L4 1例.5例患者平均随访2.4年(1.0～4.5年),均无脊髓神经损伤表现,腰背痛消失或明显缓解. 结论 PKP可发生椎管内骨水泥渗漏,但并不一定产生临床症状.术中良好的透视监护设备及正确的手术方法是减少椎管内骨水泥渗漏的重要因素之一.

Analysis of cement leakage into spinal canal in kyphoplasty

Objective To discuss the causes and prevention of bone cement leakage into the spinal canal in kyphoplasty. Methods From October 2002 to December 2007, 123 patients underwent kyphoplasty for their osteoporotic compression fractures of vertebrae. Cement leakage into the spinal canal occurred in 5 of them, 1 male and 4 females. Their average age was 57.3 (51 to 72) years. Their clinical data were analyzed retrospectively and relative literature was reviewed to find out the causes and prevention strategy. Results The causes for cement leakage were found to be rupture of vertebral posterior wall in 1 case, disruption of transpedicular puncture in 2 cases, and vertebral blood vessel in 2 cases. The cement leakage occurred at TI2 in 1 case, at L1 in 2 cases, at L3 in 1 case and at L4 in 1 ease. The average fol-lowed-up time was 2.4 ( 1.0 to 4.5) years. None of the 5 cases had manifestation of spinal cord injury. All the patients tolerated the procedure well with immediate relief of back pain after kyphoplasty and walked next day after the procedure. Conclusions Although cement leakage into the spinal canal may happen during kyphoplasty, it may not cause clinical symptoms. Good fluoroscopy monitoring and correct surgical technology during operation are the key to prevention of the cement leakage.