经皮椎体成形术与经皮椎体后凸成形术相关并发症的防治探讨(1)
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[摘要] 目的：分析经皮椎体成形术(PVP)和经皮椎体后凸成形术(PKP)常见的并发症及其发生的原因，探讨其防治策略。方法：2008年5月~2010年2月，采用C形臂X线机透视下进行PVP和PKP共86例(104个椎体)，发生并发症5例共6个椎体，对其所发生的5例并发症进行回顾性分析。结果：经PVP与PKP治疗86例104节椎体病变，其中4例骨质疏松性压缩骨折患者，共5个椎体在术中发生骨水泥(聚甲基丙烯酸甲脂，PMMA)渗漏；另外1例乳腺癌并多发胸椎转移患者1个椎体术中出现恶心、呕吐且出现轻度肺栓塞，经对症处理后均消失。并发症总发生率为5.7%(6/104)。结论：导致并发症发生的主要原因有骨质疏松较重，椎体皮质不完整，操作技术不成熟，骨水泥注入时机和注入量欠佳，术中C形臂X线机透视监测不理想，骨水泥本身的毒性等。认为严格掌握适应证及禁忌证，规范手术操作，准确掌握骨水泥注入时机和注入量，术中严密的X线透视监测及心电监护可降低并发症的发生；积极防治并发症可提高治愈率。
[关键词] 脊柱骨折；经皮椎体成形术(PVP)；经皮椎体后凸成形术(PKP)；并发症；防治
[中图分类号] R682[文献标识码]A [文章编号]1673-7210(2011)04(b)-032-03
Analysis of the therapeutic and preventive strategies to the complications of percutaneous vertebroplasty (PVP) and percutaneous kypho-plasty (PKP)
RUAN Liangfeng, CHEN Yuan, MA Jianfan, LIU Haozong
Department of Orthopaedics, the People＇s Hospital of Taishan City，Taishan 529200, China
[Abstract] Objective: To analyze the complications and the reasons, and explore the preventive strategies to percutaneous vertebroplasty (PVP) and percutaneous kypho-plasty (PKP). Methods: 86 cases (104 vertebrae) who underwent PVP or PKP under C-arm X-ray fluoroscopy from May 2008 to February 2010, 5 cases (6 vertebrae) with complications were analyzed retrospectively. Results: 86 cases (104 vertebrae) who underwent PVP or PKP, PMMA leakage occurred in 5 of 4 osteoporosis; one patient who had thoracic metastasis underwent nauseating vomiting during the operation and the patient got relieved after symptomatic therapy. The overall complication rate was 5.7% (6/104). Conclusion: Major causes of complications include severe osteoporosis， cortical incomplete, unskillful procedure, bone cement into the inappropriate timing and injection volume, unfavorable operative monitor of C-arm X-ray fluoroscopy, and toxicity of bone cement. Prevention methods included strict indication and contraindication for PVP or PKP, standardized operation, accurate timing of bone cement injection and well-planned quantity, rigorous monitoring of fluoroscopy and electrocardiograph, preventing complications positively can improve the cure rate.
[Key words] Vertebral fractures; Percutaneous vertebroplasty (PVP); Percutaneous kypho-plasty (PKP); Complications; Therapeutic and preventive strategies ......
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