经皮椎体成形术并发骨水泥外溢分型及防治.doc

经皮椎体成形术并发骨水泥外溢分型及防治 　【关键词】 经皮椎 　　Classification, prevention and treatment of bone cement leakage following percutaneous vertebroplasty 　　【Abstract】 AIM: To explore the categorization, prevention and treatment of bone cement leakage following percutaneous vertebroplasty (PVP). METHODS: PVP has been performed for vertebral angioma and vertebral body osteoporotic compression fracture in 38 cases (11 men and 27 women) since November, 2002. Followup ranged from 8 to 16 months in all cases. The curative effect was evaluated based on the standard of WHO. RESULTS: The symptoms were relieved completely or partially in all the cases. Bone cement leakage following PVP was classified into 4 types as type Ⅰ (vertebral side), type Ⅱ (intervertebral disc), type Ⅲ (vertebral canal) and type Ⅳ (mixed type). Different treatments were planned according to the different types. The experience of preventing bone cement leakage was summed up. CONCLUSION: To prevent the bone cement leakage, we should pay attention to the preoperative preparation of bone cement, the choice of the anesthesia and the monitoring of the whole operation. The patients of typeⅠ and Ⅱneed not be treated, but the patients of type Ⅲ and Ⅳ who have the symptoms of nerve compression must have an open operation. 　　【Keywords】 percutaneous vertebroplasty; bone cements; leakage 　　【摘要】目的： 介绍经皮椎体成形术（PVP）在我院的临床应用，并探讨骨水泥外溢的分型及防治. 方法： 200211选择老年性骨质疏松性椎体压缩骨折及椎体血管瘤患者38（男11，女27）例，应用经皮椎体成形术治疗. 随访8～16 mo，疗效评定采用WHO标准. 结果： 所有治疗患者的症状完全或部分缓解. 将该组患者PVP术后骨水泥外溢的情况分为四型，即Ⅰ型(椎旁型)、Ⅱ型(椎间盘型)、Ⅲ型(椎管型)和Ⅳ型(混合型)，并针对不同的分型提出治疗方案，同时总结预防骨水泥外溢的经验. 结论： 经皮椎体成形术在治疗骨质疏松性胸、腰椎压缩骨折及椎体血管瘤中，具有增强椎体强度、防止骨折移位、止痛效果确切和微创治疗等优点. 通过术前及骨水泥的准备、麻醉的选择、术中监控等，以防止骨水泥外溢. 骨水泥外溢Ⅰ，Ⅱ型无需采取治疗. Ⅲ，Ⅳ型外溢，如骨水泥漏入椎管内引起神经压迫症状，则必须采取开放手术治疗. 　　【关键词】 经皮椎体成形术；骨粘合剂；外溢 　　0引言 　　经皮椎体成形术(percutaneous vertebroplasty, PVP)是近年来在治疗骨质疏松性胸、腰椎压缩骨折及椎体血管瘤等疾患中的一种非血管性介入治疗手段. 具有增强椎体强度、防止骨折移位、止痛效果确切和微创治疗等优点. 但PVP中骨水泥外溢的并发症则是临床工作的又一难题. 我院200211起应用PVP治疗38例老年性骨质疏松性锥体压缩骨折及椎体血管瘤，对PVP中骨水泥外溢分型及防治进行了探讨. 　　1对象和方法 　　1.1对象 　　骨