实用骨科杂志
實用骨科雜誌
실용골과잡지
JOURNAL OF PRACTICAL ORTHOPEDICS
2015年
8期
679-682
,共4页
经皮椎体成形术%经皮椎体后凸成形术%胸腰椎骨折%骨质疏松%骨水泥渗漏
經皮椎體成形術%經皮椎體後凸成形術%胸腰椎骨摺%骨質疏鬆%骨水泥滲漏
경피추체성형술%경피추체후철성형술%흉요추골절%골질소송%골수니삼루
percutaneous vertebroplasty%percutaneous kyphoplasty%vertebral compression fracture%osteoporosis%cement leakage
目的：对骨质疏松性胸腰椎骨折行经皮椎体成形术（percutaneous vertebroplasty，PVP）和经皮椎体后凸成形术（percutaneous kyphoplasty，PKP）治疗术后骨水泥渗漏进行临床观察及分析。方法回顾性分析2010年1月至2014年10月治疗胸腰段骨质疏松性椎体压缩骨折78例共93个椎体，其中随机分为 PVP 组31例36个椎体，PKP 组47例57个椎体。通过术后腰椎 X 线片和 CT 检查观察患者骨水泥渗漏情况，并按椎体外骨水泥渗漏的解剖位置分6型，分别为无渗漏型、椎旁渗漏型、椎间盘渗漏型、椎管渗漏型、椎弓根渗漏型，混合渗漏型（包含两种或两种以上渗漏）。结果术后所有患者行腰椎 X 线片和 CT 检查，发现 PVP 组发生骨水泥外漏12椎（33.33％），PKP 组发生骨水泥外漏10椎（17.60％），其中 PVP 组6椎为椎旁渗漏型，2椎为椎间盘渗漏型，1椎为椎管渗漏型，2椎为椎弓根渗漏型，1椎为混合渗漏型（为椎旁渗漏合并椎管渗漏）；PKP 组5椎为椎旁渗漏型，2椎为椎管渗漏型，1椎为椎弓根渗漏型，2椎为混合渗漏型（1椎为椎旁渗漏合并椎管渗漏，1椎椎弓根渗漏合并椎管渗漏），2椎混合型渗漏患者出现神经症状，急诊行手术取出椎管内渗漏水泥后症状缓解。所有渗漏患者随访3~6个月，均未再次出现神经症状及后遗症。结论PVP 和PKP 相比较，前者骨水泥渗漏发生率较高，尤其以椎旁渗漏及椎管渗漏最为多见。
目的：對骨質疏鬆性胸腰椎骨摺行經皮椎體成形術（percutaneous vertebroplasty，PVP）和經皮椎體後凸成形術（percutaneous kyphoplasty，PKP）治療術後骨水泥滲漏進行臨床觀察及分析。方法迴顧性分析2010年1月至2014年10月治療胸腰段骨質疏鬆性椎體壓縮骨摺78例共93箇椎體，其中隨機分為 PVP 組31例36箇椎體，PKP 組47例57箇椎體。通過術後腰椎 X 線片和 CT 檢查觀察患者骨水泥滲漏情況，併按椎體外骨水泥滲漏的解剖位置分6型，分彆為無滲漏型、椎徬滲漏型、椎間盤滲漏型、椎管滲漏型、椎弓根滲漏型，混閤滲漏型（包含兩種或兩種以上滲漏）。結果術後所有患者行腰椎 X 線片和 CT 檢查，髮現 PVP 組髮生骨水泥外漏12椎（33.33％），PKP 組髮生骨水泥外漏10椎（17.60％），其中 PVP 組6椎為椎徬滲漏型，2椎為椎間盤滲漏型，1椎為椎管滲漏型，2椎為椎弓根滲漏型，1椎為混閤滲漏型（為椎徬滲漏閤併椎管滲漏）；PKP 組5椎為椎徬滲漏型，2椎為椎管滲漏型，1椎為椎弓根滲漏型，2椎為混閤滲漏型（1椎為椎徬滲漏閤併椎管滲漏，1椎椎弓根滲漏閤併椎管滲漏），2椎混閤型滲漏患者齣現神經癥狀，急診行手術取齣椎管內滲漏水泥後癥狀緩解。所有滲漏患者隨訪3~6箇月，均未再次齣現神經癥狀及後遺癥。結論PVP 和PKP 相比較，前者骨水泥滲漏髮生率較高，尤其以椎徬滲漏及椎管滲漏最為多見。
목적：대골질소송성흉요추골절행경피추체성형술（percutaneous vertebroplasty，PVP）화경피추체후철성형술（percutaneous kyphoplasty，PKP）치료술후골수니삼루진행림상관찰급분석。방법회고성분석2010년1월지2014년10월치료흉요단골질소송성추체압축골절78례공93개추체，기중수궤분위 PVP 조31례36개추체，PKP 조47례57개추체。통과술후요추 X 선편화 CT 검사관찰환자골수니삼루정황，병안추체외골수니삼루적해부위치분6형，분별위무삼루형、추방삼루형、추간반삼루형、추관삼루형、추궁근삼루형，혼합삼루형（포함량충혹량충이상삼루）。결과술후소유환자행요추 X 선편화 CT 검사，발현 PVP 조발생골수니외루12추（33.33％），PKP 조발생골수니외루10추（17.60％），기중 PVP 조6추위추방삼루형，2추위추간반삼루형，1추위추관삼루형，2추위추궁근삼루형，1추위혼합삼루형（위추방삼루합병추관삼루）；PKP 조5추위추방삼루형，2추위추관삼루형，1추위추궁근삼루형，2추위혼합삼루형（1추위추방삼루합병추관삼루，1추추궁근삼루합병추관삼루），2추혼합형삼루환자출현신경증상，급진행수술취출추관내삼루수니후증상완해。소유삼루환자수방3~6개월，균미재차출현신경증상급후유증。결론PVP 화PKP 상비교，전자골수니삼루발생솔교고，우기이추방삼루급추관삼루최위다견。
Objective To observe and analyze for cement leakage after percutaneous vertebroplasty(PVP)and percutane-ous kyphoplasty(PKP)in osteoporotic vertebral compression fracture. Methods From January 2010 to October 2014,78 pa-tients(93 vertebrae)with osteoporotic vertebral compression fracture were treated with PKP and PVP. 31 cases(36 vertebral body)were randomly divided into PVP group;PKP group holds the set of 47 cases(57 vertebral body). Computed tomography (CT)and X-ray was performed to determine and analyze the cement leakage after operation. The patterns of cement leakage were classified as six types:no leakage type;through a cortical defect or para-vertebral vein into the para-spinal tissues;via the needle channel;through a cortical defect into the disc space;leak into spinal canal and mixed cement leakage(including two or more types). Results All patients were analyzed by preoperative and postoperative CT scan in PVP group there were 12 verte-bral bodies(33. 3% )occurred cement leakage,10 vertebral bodies(17. 6% )occurred cement leakage in PKP group. PVP group had 6 para-vertebral type,1 disc type,1 spinal canal type,2 pedicle type and 1 mixed type. PKP group had 5 para-verte-bral type,2 spinal canal type,1 pedicle type and 2 mixed type. 2 patients of mixed type had neural symptoms. After the emer-gency surgery to take out the cement in the spinal canal,neural symptoms were relieved. All of patients were followed up for 3~ 6 months. None of patients had neurologic symptoms and complications again. Conclusion PVP has higher incidence of bone cement leakage than PKP. Para-vertebral type is the most common types,followed by leakage of spinal canal.
