经皮椎体成形术后骨水泥渗漏的影像学表现及相关因素探讨

目的:探讨经皮椎体成形术后骨水泥渗漏的X线征象及其相关因素与预防。方法:分析28例46椎经皮椎体成形术后患者的影像及临床资料,其中转移性肿瘤4例5椎,椎体血管瘤2例2椎,骨质疏松性压缩性骨折9例23椎,外伤性压缩性骨折13例16椎。结果:22例32椎出现骨水泥渗漏,渗漏率69.6%(32/46),静脉丛渗漏23椎,其中并发肺栓塞3例及下腔静脉骨水泥栓子1例,椎间盘渗漏4椎,针道渗漏8椎,椎旁软组织渗漏3椎,椎管内渗漏4椎。结论:经皮椎体成形术骨水泥渗漏率较高,术中加强监控及术后X线常规检查有利于尽早发现、处理骨水泥渗出,严格的掌握手术适应证及良好的手术技巧可减少并发症的发生。

Imaging findings and the investigation of related factors of bone cement leakage in percutaneous vertebroplasty

Objective:To explore X-ray findings of the bone cement leakage and the causes and prevention of its occurrence in percutaneous vertebroplasty(PVP).Methods:To analyze the imaging and clinical data of 28 patients with 46 vertebrae which PVP was performed,including 4 cases of metastatic tumors with 5 vertebrae,2 cases of vertebral hemangioma with 2 vertebrae,9 cases of osteoporotic compression fractures with 23 vertebrae,13 cases of traumatic vertebral compression fracture with 16 vertebrae.Results:The bone cement leaked in 22 patients with 32 vertebrae,with leakage rate of 69.6%(32/46).There was venous plexus leakage in 23 vertebrae in which 3 cases were complicated with pulmonary and 1 case with inferior vena cava embolism,disc leakage in 4 vertebrae,needle tract leakage in 8 vertebrae,paraspinal soft tissue leakage in 3 vertebrae and spinal canal leakage in 4 vertebrae.Conclusion:Though the rate of bone cement leakage in PVP is much higher,strengthened intraoperative monitoring and postoperative X ray can be conducive to early detection of bone cement leakage position and prevention of the potential hazards,and strict surgical indications and good surgical technique can reduce the incidence of complications.