Clinical Medical College of Jining Medical University, Jining, China.
Department of Cardiac Intensive Medicine, Affiliated Hospital of Jining Medical University, Jining, China.
Orthop Surg. 2022 Feb;14(2):456-460. doi: 10.1111/os.13192. Epub 2022 Jan 2.
Percutaneous vertebroplasty (PVP) is a minimally invasive surgical technique in which polymethyl methacrylate (PMMA) is injected into the weakened vertebral body to strengthen it. However, this procedure is associated with various complications, the most common being cement leakage. Cardiac perforation caused by cement escape into the venous system is another complication, which is rare but potentially life-threatening even if not treated promptly.
Here, we report two elderly patients who developed cardiac perforation caused by cement escape into veins following PVP. Both patients had a history of severe osteoporosis. On admission, they presented with lower back pain and limited movement. MRI revealed vertebral bodies compression fracture in both patients. Considering the advanced age of the patients, PVP was performed to avoid the risk of potential complications associated with nonoperative therapy. Unfortunately, the rare and fatal postoperative complication, cardiac perforation caused by cement escape into veins, occurred in both patients. Emergency open-heart surgery was performed to remove cement material and repair the heart, both patients recovered well and were discharged.
Although PVP is a safe and minimally invasive surgical technique, it is associated with various serious complications as seen in the present cases. We therefore recommend that surgeons should be aware of such complications. Appropriate timing of surgical operation, meticulous surgical procedures, early intraoperative and postoperative monitoring of cement leakage may improve outcomes of patients with such complications.
经皮椎体成形术（PVP）是一种微创外科技术，将聚甲基丙烯酸甲酯（PMMA）注入到脆弱的椎体中以增强其强度。然而，该手术与多种并发症相关，最常见的是水泥渗漏。水泥逸入静脉系统引起的心脏穿孔是另一种并发症，虽然不及时治疗很少见，但具有潜在的致命性。
本文报告了 2 例 PVP 术后水泥逸入静脉引起心脏穿孔的老年患者。2 例患者均有严重骨质疏松症病史。入院时，均表现为腰痛和活动受限。MRI 显示 2 例患者均有椎体压缩性骨折。考虑到患者年龄较大，行 PVP 以避免与非手术治疗相关的潜在并发症风险。不幸的是，2 例患者均发生了罕见且致命的术后并发症，即水泥逸入静脉引起的心脏穿孔。紧急开胸手术以清除水泥材料并修复心脏，2 例患者均恢复良好并出院。
尽管 PVP 是一种安全的微创外科技术，但正如本病例所见，它与各种严重并发症相关。因此，我们建议外科医生应意识到这些并发症。适当的手术时机、精细的手术操作、术中及术后早期监测水泥渗漏可能会改善此类并发症患者的预后。
