Schulz C, Efinger K, Schwarz W, Mauer U M
Abteilung Neurochirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081 Ulm, Deutschland.
Orthopade. 2012 Nov;41(11):881-8. doi: 10.1007/s00132-012-1964-1.
Kyphoplasty is associated with a low incidence of cement leakage and this usually tends to be clinically asymptomatic. However, there is a potential for life-threatening complications from extraspinal leakage resulting in vascular, cardiac and pulmonary embolisms. A total of eight cases of open surgical thrombectomy for cardiopulmonary cement leakage have been published in the current literature to date. Besides the description of a consecutive series with special reference to extraspinal cement leakage this article presents the results after successful endovascular removal of intravenous cement fragments following kyphoplasty in two patients.
In 46 cases following balloon kyphoplasty the number and amount of extraspinal venous cement leakage was retrospectively determined using computed tomography (CT). The number of cement embolisms into the pulmonary venous system was differently revealed for patients showing no extravertebral leakage or leakage only into the external vertebral venous plexus compared to leakage into the major venous vessels, azygos and hemiazygos vein or inferior vena cava.
In 8 out of 046 cases (17.4 %) leakage into the external vertebral venous plexus was detected. In 5 out of 8 cases without involvement of the azygos/hemiazygos vein or inferior vena cava no pulmonary cement embolism was detected. In 3 out of 8 cases the inferior vena cava or azygos/hemiazygos vein was reached and additionally asymptomatic peripheral pulmonary cement embolism was induced in these cases. In two cases harboring residual intravasal cement fragments treatment was successful using endovascular extraction techniques.
A computed tomography scan after kyphoplasty is recommended for all cases. If there is involvement of the inferior vena cava or the azygos/hemiazygos vein an additional CT scan of the chest should follow, even in asymptomatic cases. Residual intravasal cement fragments are safely extractable using endovascular techniques.
椎体后凸成形术的骨水泥渗漏发生率较低，且通常在临床上无症状。然而，椎体外渗漏有可能导致危及生命的并发症，进而引发血管、心脏及肺部栓塞。迄今为止，当前文献中已发表了8例因心肺骨水泥渗漏而进行开放性手术取栓的病例。除了特别提及椎体外骨水泥渗漏的连续病例系列描述外，本文还介绍了2例椎体后凸成形术后成功通过血管内取出静脉内骨水泥碎片的结果。
在46例球囊椎体后凸成形术后的病例中，采用计算机断层扫描（CT）回顾性确定椎体外静脉骨水泥渗漏的数量和量。与渗漏至主要静脉血管、奇静脉和半奇静脉或下腔静脉相比，未发生椎体外渗漏或仅渗漏至椎外静脉丛的患者，其进入肺静脉系统的骨水泥栓塞数量有所不同。
在46例病例中有8例（17.4%）检测到渗漏至椎外静脉丛。在8例未累及奇静脉/半奇静脉或下腔静脉的病例中，有5例未检测到肺部骨水泥栓塞。在8例病例中有3例累及下腔静脉或奇静脉/半奇静脉，且这些病例还诱发了无症状的外周肺部骨水泥栓塞。在2例存在残留血管内骨水泥碎片的病例中，采用血管内取出技术治疗成功。
建议对所有病例在椎体后凸成形术后进行计算机断层扫描。如果累及下腔静脉或奇静脉/半奇静脉，即使是无症状病例，也应随后进行胸部CT扫描。残留的血管内骨水泥碎片可通过血管内技术安全取出。
