骨质疏松椎体压缩性骨折强化术后椎管内骨水泥渗漏的研究
|
张海峰，占鸣，朱翰林，冯波
|
杭州市第九医院，浙江杭州，311225
|
摘要：骨质疏松椎体压缩性骨折（Osteoporotic Vertebral Compression Fracture, OVCF）是老年人群高发的脊柱损伤，经皮椎体成形术（Percutaneous Vertebroplasty, PVP）与经皮椎体后凸成形术（Percutaneous Kyphoplasty, PKP）是主要的治疗方案，但椎管内骨水泥渗漏可导致脊髓神经根压迫、截瘫等严重后果。本文基于近年国内外相关文献，系统综述OVCF 强化术后椎管内骨水泥渗漏的分型、发生率与危险因素、病理生理机制、临床表现、治疗，分析其争议问题，为临床规范化处理提供参考依据，并对未来个性化诊疗进行展望。
关健词：骨质疏松椎体压缩性骨折；经皮椎体成形术；经皮椎体后凸成形术；椎管内渗漏；骨水泥渗漏
|
Study on Intraspinal Bone Cement Leakage After Vertebral Augmentation for Osteoporotic Vertebral Compression Fractures
|
Haifeng Zhang,Ming Zhan,Hanlin Zhu,Bo Feng
Hangzhou Ninth Hospital, Hangzhou Zhejiang 311225，China
|
Abstract：Osteoporotic Vertebral Compression Fracture (OVCF) is a common spinal injury in the elderly population. Percutaneous Vertebroplasty (PVP) and Percutaneous Kyphoplasty (PKP) are the main treatment modalities.However, intraspinal bone cement leakage can lead to severe consequences such as spinal cord and nerve root compression, and even paraplegia. Based on relevant domestic and international literature in recent years, this article systematically reviews the classification, incidence, risk factors, pathophysiological mechanisms, clinical manifestations, and treatment of intraspinal bone cement leakage after OVCF augmentation. It also analyzes the controversial issues, provides a reference for standardized clinical management, and looks forward to the future of personalized diagnosis and treatment.
Keywords : Osteoporotic Vertebral Compression Fracture; Percutaneous Vertebroplasty; Percutaneous Kyphoplasty; Intraspinal Leakage; Bone Cement Leakage
参考文献
[1] 中国康复医学会骨质疏松预防与康复专业委员会. 骨质疏松性椎体压缩骨折诊治专家共识(2021 版)[J]. 中华医学杂志,2021,101(41):3371-3379.
[2] Lieberman IH, Dudeney S, Reinhardt MK, et al. Initial outcome and efficacy of“ kyphoplasty” in the treatment of painful osteoporotic vertebral compression fractures[ J]. Spine (Phila Pa 1976), 2001,26(14):1631-1638.
[3] 李庆达, 贺园, 贺宝荣. 骨质疏松性胸腰椎骨折椎体强化术后并发骨水泥渗漏的若干问题[J]. 中华创伤杂志,2022,38(3):193-197.
[4] Hsieh MK, Kao FC, Chiu PY, et al. Risk factors of neurological deficit and pulmonary cement embolism after percutaneous vertebroplasty[J].J Orthop Surg Res, 2019, 14(1):406.
[5] 荆志振, 李利军, 崔小平, 等. 经皮椎体成形术后症状性骨水泥椎管内渗漏的个体化治疗选择及疗效评价[J]. 中华创伤杂志,2021,37(5):422-428.
[6] Teng MM,Cheng H, Ho DM,etal.Intraspinal leakage of bone cement after vertebroplasty: a report of 3 cases[J]. AJNR Am J Neuroradiol,2006,27(1):224-229.
[7] Yeom JS, Kim WJ, Choy WS, et al. Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures[J].J Bone Joint Surg Br,2003,85(1):83-89.
[8] Tomé-Bermejo F,Pi?era AR,Duran-álvarez C,etal.Identification of risk factors for the occurrence of cement leakage during percutaneous vertebroplasty for painful osteoporotic or malignant vertebral fracture[J].Spine (Phila Pa 1976),2014,39(11):E693-E700.
[9] 张帅, 王清, 杨进, 等. 经皮椎体后凸成形术骨水泥椎管内渗漏发生率及相关危险因素分析[J]. 中国矫形外科杂志,2018,26(24):2244-2249.
[10] 齐新生, 茅治湘, 王全明, 等. 经皮椎体成形术骨水泥外渗原因及对策[J]. 江苏医药,2007,33(8):806-807.
[11] Zhu RS, Kan SL,Ning GZ,etal.Which is the best treatment of osteoporotic vertebral compression fractures: balloon kyphoplasty,percutaneous vertebroplasty,or non-surgical treatment? A Bayesian network meta-analysis[ J].Osteoporos Int,2019,30(2):287-298.
[12] 张翼, 寇红伟, 尚国伟, 等. 骨质疏松性椎体压缩骨折行经皮椎体成形术后骨水泥渗漏危险因素分析[J]. 中华创伤杂志,2022,38(5):396-400.
[13] Nieuwenhuijse MJ,Van Erkel AR,Dijkstra PD.Cement leakage in percutaneous vertebroplasty for osteoporotic vertebral compression fractures:identification of risk factors[J].Spine J,2011,11(9):839-848.
[14] Hong SJ,Lee S,Yoon JS,etal.Analysis of intradiscal cement leakage during percutaneous vertebroplasty:multivariate study of risk factors emphasizing preoperative MR findings[J].J Neuroradiol,2014,41(3):195-201.
[15] 林铖, 陈唐亦衡, 刘义杰, 等. 骨质疏松性椎体压缩骨折行经皮椎体后凸成形术后骨水泥渗漏和伤椎再塌陷的危险因素分析[J]. 中华创伤杂志,2022,38(6):531-537.
[16] Zhong BY,He SC, Zhu HD,etal.Nomogram for predicting intradiscal cement leakage following percutaneous vertebroplasty in patients with osteoporotic related vertebral compression fractures[J].Pain Physician, 2017,20(4):E513-E520.
[17] Lin J,Qian L,Jiang C,etal.Bone cement distribution is a potential predictor to the reconstructive effects of unilateral percutaneous kyphoplasty in OVCFs: a retrospec-tive study[J].J Orthop Surg Res,2018,13(1):140.
[18] Tang B, Xu S,Chen X,et al.The impact of intravertebral cleft on cement leakage in percutaneous vertebroplasty for osteoporotic vertebral compression fractures: a case-control study[J].BMC Musculoskelet Disord, 2021,22(1):805.
[19] Zhu SY,Zhong ZM,Wu Q,et al.Risk factors for bone cement leakage in percutaneous vertebroplasty: a retrospective study of four hundred and eighty five patients[ J].Int Orthop,2016, 40(6):1205-1210.
[20] Zhan Y,Jiang JZ,Liao HF,etal.Risk factors for cement leakage after vertebroplasty or kyphoplasty:a meta-analysis of published evidence[J].World Neurosurg, 2017,101:633-642.
[21] 杨惠林, 刘强, 唐海, 等. 经皮椎体后凸成形术的规范化操作及相关问题的专家共识[J]. 中华医学杂志,2018,98(11):808-812.
[22] Chen W,Xie W,Xiao Z,etal.Incidence of cement leakage between unilateral and bilateral percutaneous vertebral augmentation for osteoporotic vertebral compression fractures:a meta-analysis of randomized controlled trials[ J].World Neurosurg,2019,122:342-348.
[23] 王坤龙, 齐向北, 王鹏飞, 等. 高、低黏度骨水泥椎体成形术后生物力学及渗漏率的研究[J]. 中华实验外科杂志,2018,35(6):1126-1128.
[24] 徐超, 伊力哈木· 托合提, 李国华, 等. 高粘度与低粘度骨水泥PVP 治疗骨质疏松椎体压缩骨折的疗效和并发症[J]. 中国脊柱脊髓杂志,2014,24(10):900-905.
[25] 何仁建, 余超, 罗园超, 等.Mimics 软件评估椎体成形中骨水泥的安全剂量[ J ] . 中国组织工程研究,2021,25(10):1482-1488.
[26] 柏涛, 纳强, 张雄文, 等. 经皮椎体强化术中分次调配骨水泥、靶点封堵裂口防止经椎体前壁骨水泥渗漏的效果[J]. 中国骨与关节损伤杂志,2021,36(1):55-56.
[27] G uan H,Yang H,Mei X,etal.Early or delayed operation, which is more optimal for kyphoplasty? A retrospective study on cement leakage during kyphoplasty[J]. Injury,2012,43(10):1698-1703.
[28] Belkoff SM, Molloy S.Temperature measurement during polymerization of polymethylmethacrylate cement used for vertebroplasty[J].Spine(Phila Pa 1976),2003,28(10):1055-1059.
[29] 刘晓光, 刘忠军, 陈仲强, 等.“涵洞塌陷法”360°脊髓环形减压术治疗胸椎管狭窄症[J]. 中华骨科杂志,2010,30(11):1059-1062.
[30] Bhide RP,Barman A,Varghese SM,etal.A rare presentation of subacute progressive ascending myelopathy secondary to cement leakage in percutaneous vertebroplasty[ J].Am J Phys Med Rehabil,2014,93(5):431-436.
[31] Vasconcelos C,Gailloud P,Martin JB,etal.Transient arterial hypotension induced by polymethylmethacrylate injection during percutaneous vertebroplasty[J].J Vasc Interv Radiol,2001,12(8):1001-1002.
[32] 王远政, 李波, 郭涛, 等. 骨水泥强化椎弓根螺钉内固定治疗胸腰椎经皮椎体后凸成形术后手术椎体再骨折的疗效分析[J]. 中华创伤杂志,2017,33(11):1005-1010.
[33] Omidi-Kashani F,Ebrahimzadeh M,Peivandy M.Late onset sciatalgia as a rare complication of percutaneous vertebroplasty:a case report[J].Cases J,2009,2:7960.
[34] 宁磊, 万双林, 杨明, 等. 经皮椎体后凸成形术后非骨折椎体骨折的原因分析[ J ] . 中华骨科杂志,2015,35(10):990-996.
[35] 孙钢. 经皮椎体强化术并发症发生及对策[J]. 介入放射学杂志,2017,26(9):769-774.
[36] Wagner AL,Telfeian AE,Iprenburg M,etal.Transforaminal endoscopic solution to a kyphoplasty complication:technical note[J].World Neurosurg, 2016,91:195-198.
[37] Bose R, Choi JW.Successful percutaneous retrieval of methyl methacrylate orthopedic cement embolism from the pulmonary artery[J].Catheter Cardiovasc Interv, 2010,76(2):198-201.
|
|
|
论文收录证明 / 文献检索报告
Document Retrieval Certificate / Proof of Publication Indexing
作者贡献声明 / 贡献确认书
Author Contribution Statement / Certificate of Authorship Contribution
同行评审报告 / 评审意见
Peer Review Report / Peer Review Comments
利益冲突
Conflict of Interest
作者声明不存在任何利益冲突。
The author declares no conflict of interest.
|
|
