椎体内部强化术治疗骨质疏松性椎体压缩骨折并发骨水泥渗漏的临床观察

目的：探讨椎体内部强化术,包括经皮椎体成形术（PVP）、椎体后凸成形术（PKP）,并发骨水泥渗漏的发生率、主要影响因素、渗漏途径及预防措施。方法：对2010年1月至2012年1月因骨质疏松性椎体压缩骨折（OVCFs）、椎体转移瘤、椎体血管瘤接受椎体内部强化术的94例患者的临床资料进行回顾性分析,其中男39例,女55例;年龄55-86岁,平均69.4岁。分析椎体内部强化术并发骨水泥渗漏的原因、类型、发生率及并发症等。结果：21例患者的26个椎体发生渗漏,椎体静脉途径、骨皮质途径是骨水泥渗漏的主要途径,渗漏以邻近椎间盘、椎体周围渗漏为主,且多数为无症状性渗漏。在治疗骨质疏松性椎体压缩骨折方面椎体后凸成形术比经皮椎体成形术骨水泥渗漏发生率低（P〈0.05）,经皮椎体成形术治疗椎体肿瘤时的骨水泥渗漏发生率高于治疗骨质疏松性椎体压缩骨折时（P〈0.05）。结论：骨水泥渗漏是经皮椎体成形术、椎体后凸成形术常见的并发症,术前仔细分析、术中严密监测并严格掌握手术适应证可减少其发生。

Vertebral internal reinforcement operation for the treatment of osteoporotic vertebral compressive fractures combined with bone cement leakage

Objective: To explore incidence rate,influencing factors,leakage routes,and preventative measures of bone cement leakages in vertebral internal reinforcement operation including percutaneous vertebroplasty and percutaneous kyphoplasty. Methods: From January 2010 to January 2012,94 patients with osteoporotic vertebral compressive fracture,vertebral metastases and vertebral hemangioma were treated by vertebral internal reinforcement operation. Among them,there were 39 males and 55 females aged 55 to 86 with an average of 69.4 years old. The reasons,types,incidence and complications of bone cement leakage were analyzed. Results: Totally 21 patients (26 vertebral) occurred bone cement leakage,the main routes included basivertebral veins,and bone cortex,which mainly located on adjacent intervertebrae and around vertebral body,and most of them were asymptomatic leakage. For the treatment of OVCFs,incidence of bone cement leakage in PKP was lower than that of PVP(P<0.05),while incidince of PVP in treating vertebral metastases was worse than in treating OVCFs(P<0.05). Conclusion: Bone cement leakage is a common complication in PVP and PKP. Careful analysis before operation,cautiously monitors and grasp operation indication in operation can decrease incidence of it.