Sun Qi-Cai, Ru Xuan-Liang, Song Bai-Shan, Duanmu Qun-Li
Zhejiang Hospital, Hangzhou 310013, Zhejiang, China;
Zhejiang Hospital, Hangzhou 310013, Zhejiang, China.
Zhongguo Gu Shang. 2017 Sep 25;30(9):810-816. doi: 10.3969/j.issn.1003-0034.2017.09.006.
To retrospectively analyze the clinical data of 17 patients with bone cement leakage after percutaneous kyphoplasty and explore the leakage type and mid-term clinical effects.
The clinical data of 17 patients with osteoporotic vertebral compression fractures occurred bone cement leakage after percutaneous kyphoplasty from October 2011 to October 2016 were collected. There were 7 males and 10 females, aged from 68 to 87 years old with an average of 78 years. All the patients had the history of low emergy trauma who had normal activity and full self-care for living before trauma, and complained with the lower back pain without signs and symptoms of nerve root injury after trauma. According to the anatomical location by images, the bone cement leakage pathways was confirmed, the preoperative and postoperative vertebral body height and Cobb angle were measured, the improvement of spinal stenosis were recorded. Preoperative and postoperative visual analogue scale (VAS) and Oswestry Disability Index(ODI) were used to evaluate pain and daily activities.
All the patients were followed up for 4 to 7 years with an average of 5.1 years. According to anatomical location by images, we found the bone cement leakage pathways of vertebral side type in 6 cases, intervertebral disc type in 3 cases, spinal canal type in 2 cases, vertebral pedicle type in 5 cases and mixed type in 1 case. Vertebral body height from preoperative(27.7±3.5)% restored to (56.4±2.5)% at final follow-up, and the kyphosis was corrected with Cobb angle from preoperative(45.3±4.2)° corrected to(18.3±3.1)° at final follow-up. VAS score decreased from preoperative 7.9±1.5 to 2.1±0.5 at final follow-up. ODI obviously restored from preoperative(49.1±7.5)% to (23.5±3.7)% at final follow-up. The nerve symptoms in lower limbs occurred in 2 cases, and the neurological symptom was disappeared after urgent symptomatic treatment and anaphase trophic nerve treating. Lower back pain occurred in 3 cases, including one case of unbearable pain, and the pain disappeared after symptomatic treatment.
Although the rate of bone cement leakage during percutaneous vertebral kyphoplasty is not low, the bone cement leakage has little influence on PKP surgery. Even if a little leakage occurred within the spinal canal during the surgery, spinal canal decompression will not be needed urgently. The significant clinical symptoms caused by leakage can basically disappear after treatment in mid-term follow-up.
回顾性分析17例经皮椎体后凸成形术后骨水泥渗漏患者的临床资料，探讨渗漏类型及中期临床疗效。
收集2011年10月至2016年10月行经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折后发生骨水泥渗漏的17例患者的临床资料。其中男性7例，女性10例，年龄68～87岁，平均78岁。所有患者均有低能量外伤史，外伤前活动正常，生活完全自理，外伤后出现下腰痛，无神经根损伤体征及症状。根据影像学解剖位置确定骨水泥渗漏途径，测量术前及术后椎体高度和Cobb角，记录椎管狭窄改善情况。采用术前及术后视觉模拟评分法（VAS）和Oswestry功能障碍指数（ODI）评估疼痛及日常活动情况。
所有患者均随访4～7年，平均5.1年。根据影像学解剖位置，发现椎体侧方型骨水泥渗漏6例，椎间盘型3例，椎管型2例，椎弓根型5例，混合型1例。末次随访时椎体高度由术前的（27.7±3.5）%恢复至（56.4±2.5）%，后凸畸形矫正，Cobb角由术前的（45.3±4.2）°矫正至末次随访时的（18.3±3.1）°。VAS评分由术前的7.9±1.5降至末次随访时的2.1±0.5。ODI由术前的（49.1±7.5）%明显恢复至末次随访时的（23.5±3.7）%。发生下肢神经症状2例，经紧急对症治疗及后期营养神经治疗后神经症状消失。发生下腰痛3例，其中1例疼痛难忍，经对症治疗后疼痛消失。
经皮椎体后凸成形术中骨水泥渗漏率虽不低，但骨水泥渗漏对PKP手术影响不大。即使术中椎管内有少量渗漏，也无需紧急椎管减压。渗漏引起的明显临床症状在中期随访治疗后基本可消失。
