Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Twmpath Lane, Oswestry, Shropshire, SY10 7AG, UK.
Skeletal Radiol. 2012 Sep;41(9):1093-8. doi: 10.1007/s00256-011-1348-3. Epub 2012 Jan 15.
We noted a large amount of intravenous gas during balloon kyphoplasty on CT imaging. Formal assessment to understand the extent, possible causes and implications was undertaken.
Ten consecutive cases of balloon kyphoplasty were performed under general anaesthesia in the prone position, on a single vertebral level using a two-step technique under combined fluoroscopic and CT guidance. CT of the affected vertebra was performed before, after, and intermittently during the procedure. In 2 cases delayed CT was carried out in the supine position.
Gas was seen on CT imaging, but not on conventional fluoroscopy. The gas is most likely to be air introduced during the procedure and was seen in the epidural and paravertebral venous plexus, posterior intercostal veins, renal veins, IVC and azygos vein. The average measured volume of gas seen on the post-procedure CT imaging was 1.07 mL, range 0.16-3.97 mL. There was no correlation of the measured amount of gas to the procedure duration or location, the use of a curette or the injected cement volume. Delayed CT in the supine position no longer showed air in the local venous system.
Balloon kyphoplasty is associated with the fluoroscopically invisible introduction of air into the vertebral and paravertebral veins and deep systemic veins and is likely to be much more extensive than identified on CT imaging. There is potential for serious air embolism in kyphoplasty and if there is a sudden deterioration in patient condition during the procedure the possibility of this complication needs to be considered.
我们在 CT 成像上注意到球囊扩张椎体后凸成形术中存在大量静脉内气体。我们对其程度、可能的原因和影响进行了正式评估。
连续 10 例球囊扩张椎体后凸成形术在全身麻醉下进行，患者取俯卧位，采用两步法，在透视和 CT 联合引导下，于单一椎体水平进行。在术前、术后及术中间断对受累椎体进行 CT 检查。2 例患者延迟至仰卧位行 CT 检查。
CT 成像上可见气体，但常规透视上不可见。这些气体很可能是在手术过程中引入的，分布在硬膜外和椎旁静脉丛、肋间后静脉、肾静脉、IVC 和奇静脉。术后 CT 成像上测量到的气体平均体积为 1.07mL，范围为 0.16-3.97mL。测量到的气体量与手术时间或部位、使用刮匙或注入的水泥量均无相关性。仰卧位延迟 CT 检查不再显示局部静脉系统中的空气。
球囊扩张椎体后凸成形术可导致术中空气进入椎体和椎旁静脉以及深部全身静脉，其范围比 CT 成像上显示的要广泛得多。在椎体后凸成形术中存在严重空气栓塞的风险，如果患者在手术过程中突然出现病情恶化，需要考虑到这种并发症的可能性。
