经皮椎体成形术并发症分析.docVIP

经皮椎体成形术并发症分析 作者：黄承军，唐福宇，娄宇明，刘保新 【摘要】 ［目的］探讨经皮椎体成形术并发症的发生原因及防治。［方法］自2002年8月～2006年6月共行经皮椎体成形术140例233个椎体，观察术中、术后并发症；随访7～52个月（平均28.4个月），观察经过处理后的并发症的预后及远期并发症。［结果］140例患者中，61例出现并发症，发生率为43.6%。骨水泥漏45例，其中，12例骨水泥漏出现临床症状需要处理，疼痛加重10例，胸背部及下肢放射痛1例，给予消炎止痛药物口服后3～7 d后消失，双下肢软瘫1例，CT提示椎管内骨水泥漏，急诊行椎板减压取出骨水泥，术后经过抗炎、脱水、激素、营养神经、针灸等处理，3个月后恢复行走能力，26个月后，仅仅遗留下肢无力症状；一过性低血压和意识障碍2例，经过补液、吸氧等处理后于术后30～60 min恢复； 呼吸困难、呛咳和胸部不适3例，拍片未发现明显异常，给予补液、吸氧、抗炎等处理后于3～5 d消失；皮下血肿1例，于术后1周消失；术后1～12个月，相邻椎体新发骨折10例，分别进行保守治疗或再次行PVP手术而治愈。［结论］骨水泥漏是PVP最常见的并发症，严格把握适应证和提高手术技巧有助于减少PVP并发症的发生。 【关键词】 脊柱骨折；椎体成形术；并发症；防治 　　Analysis of the complications of percutaneous vertebroplasty 　　Abstract：［Objective］To analyze the causes of complication following percutaneous vertebroplasty and to find out the methods on its prevention and treatment.［Method］Complications of 140 patients (233 vertebral bodies) performed percutaneous vertebroplasty from August 2002 to July 2006 and longterm complications and its correlative prognosis after followedup 7-52 months (average 28.4 months were observed and analyzed.［Result］Sixtyone patients of 140 cases showed complications (43.6%).Fortyfive of the 61 patients with complications revealed with leakage of bone cement,2 with transient low blood pressure or lethargy,3 with dyspneic respiration or slight cough or chest discomfort, 1 with subcutaneous herniation.In 12 patients complicated with leakage of bone cement,10 complained aggravation of pain,1 of radiating pain of back and low limb,1 with incomplete paraplegia. The 11 patients complicated with various postoperative pain induced by bonecement leakage were complete recovery after treatment with antiimflamatory analgetics orally for 3-7 days.One patient with incomplete paraplagia caused by leakage of bone cement demonstrated satisfactory walking function recovery but still remained slight disability of lower limbs after 26 months by treatment of laminectomy decompression, with drawing of bone cemen