Bhatia Chandra, Barzilay Yair, Krishna Manoj, Friesem Tai, Pollock Raymond
Department of Orthopaedics, University Hospital of North Tees, Hardwick, Stockton on Tees, UK.
Spine (Phila Pa 1976). 2006 Apr 15;31(8):915-9. doi: 10.1097/01.brs.0000209307.03930.38.
Prospective case series.
To determine the safety and feasibility of routine preinjection of gelfoam embolization during percutaneous vertebroplasty.
Percutaneous vertebroplasty has been used effectively in pain relief for vertebral fractures resulting from malignancy and osteoporosis. However, cement extrusion is a common problem and can lead to complications. Gelfoam embolization of venous channels before cement injection has not been widely used as a technique to prevent leakage.
Thirty-one patients who met the inclusion-exclusion criteria for the study underwent percutaneous vertebroplasty. Venography was first performed to determine the flow pattern in the vertebrae and confirm needle placement. Next, routine gelfoam embolization of venous channels was performed. This was followed by low-pressure, minimal-volume cement injection. The outcome measure of cement leakage was assessed after surgery using radiographs and CT scans.
There were no complications. In the 31 patients, 61 levels of vertebroplasty were performed. Overall, there were 16 leaks out of 61 levels in 12 patients (26.2%). In osteoporotic fractures, there were 11 leaks in 49 levels, giving a leakage rate of 22.5%. There was only 1 epidural leak in this group (2%), and this was asymptomatic. Seven leakages were into the adjacent disc, 2 into the body, and 1 into the paravertebral tissues. In malignant fractures, there were 5 leakages out of 12 levels (41.7%). Of these, 2 were epidural leaks (16.7%), which were asymptomatic.
Complications resulting from leakage are the most feared side effect of the procedure. This has resulted in only limited application of vertebroplasty in the United Kingdom. Routine gelfoam embolization together with careful technique has been shown to be a safe and feasible method during vertebroplasty.
前瞻性病例系列研究。
确定经皮椎体成形术中常规预先注射明胶海绵栓塞的安全性和可行性。
经皮椎体成形术已有效地用于缓解因恶性肿瘤和骨质疏松症导致的椎体骨折引起的疼痛。然而，骨水泥渗漏是一个常见问题，可导致并发症。在注射骨水泥前对静脉通道进行明胶海绵栓塞作为一种预防渗漏的技术尚未得到广泛应用。
31例符合本研究纳入 - 排除标准的患者接受了经皮椎体成形术。首先进行静脉造影以确定椎体中的血流模式并确认穿刺针位置。接下来，对静脉通道进行常规明胶海绵栓塞。随后进行低压、小剂量骨水泥注射。术后通过X线片和CT扫描评估骨水泥渗漏的结果指标。
无并发症发生。31例患者共进行了61个椎体节段的椎体成形术。总体而言，61个节段中有16个节段发生渗漏，涉及12例患者（26.2%）。在骨质疏松性骨折中，49个节段中有11个节段发生渗漏，渗漏率为22.5%。该组中仅有1例硬膜外渗漏（2%），且无症状。7例渗漏进入相邻椎间盘，2例进入椎体，1例进入椎旁组织。在恶性骨折中，12个节段中有5个节段发生渗漏（41.7%）。其中，2例为硬膜外渗漏（16.7%），无症状。
渗漏引起的并发症是该手术最令人担忧的副作用。这导致椎体成形术在英国的应用有限。在椎体成形术中，常规明胶海绵栓塞结合精细操作已被证明是一种安全可行的方法。
