经皮椎体成形术治疗骨质疏松性脊柱压缩骨折的效果及并发症的防治

目的探讨经皮椎体成形术在治疗骨质疏松性脊柱压缩骨折的效果及其并发症骨水泥渗漏的原因及对策。方法施行67例82个椎体经皮椎体成形术,男13例,女54例。年龄36～80岁,平均67.3岁。其中胸椎52个,腰椎30个。全组发生骨水泥渗漏5例,对此并发症的防治进行了分析。结果全部穿刺成功。术后随访平均26个月,效果优者58例占86.6%,良者7例占10.4%,差者2例占3%,1例疼痛加重,5例疼痛未完全消失,优良率97%。术中发生静脉渗漏致呼吸困难1例,发生注药时局部短时疼痛加重34例,骨水泥渗漏5例,渗漏率7.5%,但未发生不良后果。结论椎体成形术是治疗骨质疏松性脊柱压缩骨折的一种有效方法。对术中骨水泥渗漏只要及时发现、及时处理,多不影响疗效。防范的关键是一定要在X线机监视下操作,发现渗漏立即停止注射。

Treatment of vertebral compression fracture due to osteoporosis with percutaneous vertebroplasty and prevention of its complications

Objective To investigate the effect of percutaneous vertebroplasty(PVP)in the treat- ment of vertebral compression fracture due to osteoperosis and the causes and prevention of bone cement leakage.Methods PVP was performed in 82 centrums of 67 cases of vertebral lesions,including 13 male and 54 female patients.Their ages ranged from 36 to 80 years,with an average age of 67.3.Of which 52 lesions were in thoracic vertebra and 30 in lumbar.Five of them had bone cement leakage.The prevention of the complications was analyzed.Results The procedure was successful in all cases.The postoperative follow-up lasted 26 days on the average.Fifty-eight cases had excellent effectiveness,accounting for 86.6%;seven cases had good effectiveness,accounting for 10.4%;two cases had poor effectiveness, accounting for 3%.Pain was aggravated in one case and not relieved completely in 5 cases.The effective rate was 97%.One case of dyspnea was caused by venous leakage,34 cases of transient pain in the locations of injection and 5 cases of bone cement leakage(7.5% leakage rate)were noted,but no adverse outcome occurred.Conclusion Percutaneous vertebroplasty is an effective method for the treatment of vertebral compression fracture due to osteoperosis.The curative effect is not influenced as long as leakage of bone cement during the procedure can be detected and treated in time.The keys to prevent the complica- tions are to operate under the monitor of X-ray and to stop injection immediately if the leakage was detected.