CAJ | 학술논문

背景:经皮椎体成形和经皮椎体后凸成形是近年来微创脊柱外科常用的技术,随着其临床应用越来越多,主要并发症骨水泥渗漏也越来越多地见于临床报道. 目的:综述经皮椎体成形和经皮椎体后凸成形治疗中骨水泥渗漏的研究进展. 方法:由第一作者检索2000至2011年 PubMed数据及万方数据库有关经皮椎体后凸成形和经皮椎体成形治疗骨水泥渗漏的分类、相关危险因素、对机体的影响、防治等方面的文献. 结果与结论:经皮椎体后凸成形治疗的骨水泥渗漏率低于经皮椎体成形治疗.注射少量骨水泥即可恢复压缩椎体的刚度,一般腰椎注射4-6 mL,胸椎可适当加大剂量.术者需准确把握骨水泥的注射时机,注入调制后时间>10 min的骨水泥,骨水泥呈面团状,渗漏率低.椎体周壁破损时行两种治疗发生骨水泥渗漏的概率增大.两者骨水泥渗漏引起肺栓塞的概率较低,但一旦发生,后果严重,对心血管系统也有一定影响,因此,需严格掌握手术适应证,正确选择进针点和穿刺入路,严格把握骨水泥的注射时机和剂量,以精确的术中操作和优质的术中监测将骨水泥渗漏风险降至最低.
배경:경피추체성형화경피추체후철성형시근년래미창척주외과상용적기술,수착기림상응용월래월다,주요병발증골수니삼루야월래월다지견우림상보도. 목적:종술경피추체성형화경피추체후철성형치료중골수니삼루적연구진전. 방법:유제일작자검색2000지2011년 PubMed수거급만방수거고유관경피추체후철성형화경피추체성형치료골수니삼루적분류、상관위험인소、대궤체적영향、방치등방면적문헌. 결과여결론:경피추체후철성형치료적골수니삼루솔저우경피추체성형치료.주사소량골수니즉가회복압축추체적강도,일반요추주사4-6 mL,흉추가괄당가대제량.술자수준학파악골수니적주사시궤,주입조제후시간>10 min적골수니,골수니정면단상,삼루솔저.추체주벽파손시행량충치료발생골수니삼루적개솔증대.량자골수니삼루인기폐전새적개솔교저,단일단발생,후과엄중,대심혈관계통야유일정영향,인차,수엄격장악수술괄응증,정학선택진침점화천자입로,엄격파악골수니적주사시궤화제량,이정학적술중조작화우질적술중감측장골수니삼루풍험강지최저.
BACKGROUND:Percutaneous vertebroplasty and percutaneous kyphoplasty are commonly used in minimal y invasive spine surgery in recent years. However, with the clinical development, bone cement leakage that is the main @@@@complication of percutaneous vertebroplasty and percutaneous kyphoplasty is also increasingly found in clinical reports. @@@@OBJECTIVE:To review the research progress in bone cement leakage during percutaneous vertebroplasty and percutaneous kyphoplasty. @@@@METHODS:The articles (2000/2011) about classification, related risk factors, the influence on the body, prevention and cure related to bone cement leakage during percutaneous vertebroplasty and percutaneous kyphoplasty were retrieved by the first author in the PubMed and Wanfang databases. @@@@RESULTS AND CONCLUSION:Percutaneous kyphoplasty has a lower rate of bone cement leakage compared with percutaneous vertebroplasty. A smal dosage of bone cement injection can restore the stiffness of the compressed vertebral. For the lumbar vertebra, 4 to 6 mL bone cement is enough. The injection dose can be increased for the thoracic vertebrae. Surgeons need to grasp the opportunity of bone cement injection. When we inject the bone cement over 10 minutes after modulation, the leakage rate of bone cement is low. When the vertebral wal is incomplete, the cement leakage rate is increased in the percutaneous vertebroplasty and percutaneous kyphoplasty. The chance of pulmonary embolism caused by bone cement leakage during percutaneous vertebroplasty and percutaneous kyphoplasty is low. But if it happens, it could lead to serious consequences, and also has certain effects on the cardiovascular system. Therefore, we must grasp the operation indication strictly, and choose the right entry point and the puncture path. We should control the dosage of bone cement and the injection timing correctly by precise operation and high-quality intraoperative monitoring to minimize the risk of bone cement leakage.