CAJ | 학술논문

目的探讨经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCFs)的并发症及预防措施.方法 2004年1月至2012年12月期间在广东医学院附属南山医院采取PKP及PKP合并椎体成形术(percutaneous vertebroplasty,PVP)治疗的OVCFs 112例,共126个椎体.回顾性总结治疗中的各种并发症及其发生比例,分析其原因及预防措施.结果围手术期的并发症总发生率为54％,骨水泥渗漏66例(占52.4％),其中1例椎管内渗漏术后出现高热,对症治疗1周后症状消失,未出现神经损伤症状,其他渗漏多数发生在椎前渗漏,少数出现终板破裂渗漏及椎板后渗漏.所有患者均无肺栓塞发生,未出现骨水泥的毒性反应,无穿刺导致动脉、神经根损伤,暂时性脊髓损伤1例,椎体穿刺错误1例,球囊破裂1例,疼痛缓解不明显1例,无术后感染病例.结论骨水泥渗漏是PKP治疗OVCFs中最常见的并发症,其他并发症发生较少.严格掌握手术指征,把握骨水泥的填充量,提高手术技巧,以明显减少并发症的发生.
목적 탐토경피추체후철성형술(percutaneous kyphoplasty,PKP)치료골질소송성추체압축골절(osteoporotic vertebral compression fracture,OVCFs)적병발증급예방조시.방법 2004년1월지2012년12월기간재엄동의학원부속남산의원채취PKP급PKP합병추체성형술(percutaneous vertebroplasty,PVP)치료적OVCFs 112례,공126개추체.회고성총결치료중적각충병발증급기발생비례,분석기원인급예방조시.결과 위수술기적병발증총발생솔위54％,골수니삼루66례(점52.4％),기중1례추관내삼루술후출현고열,대증치료1주후증상소실,미출현신경손상증상,기타삼루다수발생재추전삼루,소수출현종판파렬삼루급추판후삼루.소유환자균무폐전새발생,미출현골수니적독성반응,무천자도치동맥、신경근손상,잠시성척수손상1례,추체천자착오1례,구낭파렬1례,동통완해불명현1례,무술후감염병례.결론 골수니삼루시PKP치료OVCFs중최상견적병발증,기타병발증발생교소.엄격장악수술지정,파악골수니적전충량,제고수술기교,이명현감소병발증적발생.
Objective To discuss the complications of percutaneous kyphoplasty (PKP) in treatment of osteoporotic compression fractures (OVCFs) of the thoracic and lumbar vertebrae,and to investigate their causes and prevention.Methods From Jan.2004 to Dec.2012,PKP or PKP combined with percutaneous vertebroplasty(PVP) was performed on 126 vertebrae in 112 thoracolumbar OVCFs patients.There were 21 males and 91 females.The average age was 69 years (ranging from 36 to 85).100 cases had single vertebra,10 cases had double vertebrae,and 2 cases had 3 vertebrae.The injured segments were identified by MRI before surgery,and the fractures of the vertebrae were observed clearly by X ray and CT scan.The causes of the complications were retrospective analyzed.Results Perioperative complication happened in 68 cases (54％).The leakage of the bone cement happened in 66 cases (52.4％):one of them had high fever after the leakage happened behind the post-wall of the vertebra body,and it disappeared after one week with the relevant treatment.There was no injury of the nerve.Most of the leakage happened in front of the vertebra body,few happened in the terminal plate,and few happened behind the vertebral plate.There was no pulmonary embolism.Toxic reaction of the bone cement wasn't found in this team.There was no artery or nerve injury.One temporary spinal cord injury happened,one case was punctured in a wrong vertebra,and balloon rupture happened in one case.One case didn't achieve pain release.No infection happened.Conclusion The bone cement leakage was the most common complication associated with PKP in treatment of OVCFs.The complication rate can be reduced if the operation indications are strict,the volume of the filling cementis is well controlled,and the operation is performed in experienced hands.