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[1]李慶龍,吳愛憫,倪文飛,等.經(jīng)皮椎體后凸成形術(shù)治療骨質(zhì)疏松性椎體骨折的常見并發(fā)癥分析[J].中醫(yī)正骨,2014,26(03):40-43.
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經(jīng)皮椎體后凸成形術(shù)治療骨質(zhì)疏松性椎體骨折的常見并發(fā) 癥分析()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第26卷
期數(shù):
2014年03期
頁碼:
40-43
欄目:
脊柱微創(chuàng)技術(shù)
出版日期:
2014-03-30

文章信息/Info

作者:
李慶龍吳愛憫倪文飛黃其杉王向陽林焱毛方敏徐華梓池永龍
溫州醫(yī)科大學附屬第二醫(yī)院,浙江 溫州 325027
關(guān)鍵詞:
脊柱骨折 骨折壓縮性 骨質(zhì)疏松性骨折 椎體后凸成形術(shù) 手術(shù)后并發(fā)癥
摘要:
目的:探討經(jīng)皮椎體后凸成形術(shù)治療骨質(zhì)疏松性椎體骨折的常見并發(fā)癥及其對治療效果的影響。方法:采用經(jīng)皮椎體后凸成形術(shù)治療骨質(zhì)疏松性椎體骨折患者232例(266椎),T6骨折2椎、T7骨折10椎、T8骨折6椎、T9骨折7椎、T10骨折11椎、T11骨折27椎、T12骨折69椎、L1骨折82椎、L2骨折33椎、L3骨折12椎、L4骨折6椎、L5骨折1椎。術(shù)后嚴密觀察患者生命體征,術(shù)后和隨訪時常規(guī)進行X線檢查,觀察骨水泥灌注及鄰椎骨折發(fā)生情況。并于術(shù)后1周內(nèi)進行傷椎CT薄層掃描及二維重建,按照倪文飛等的標準將骨水泥滲漏分為椎體周圍滲漏、椎管內(nèi)滲漏、椎間孔內(nèi)滲漏、椎間隙滲漏、椎旁軟組織內(nèi)滲漏及混合型滲漏,分析椎間隙滲漏與鄰椎骨折的關(guān)系。結(jié)果:①骨水泥滲漏情況。29椎發(fā)生骨水泥滲漏,T7滲漏1椎、T10滲漏1椎、T11滲漏3椎、T12滲漏9椎、L1滲漏11椎、L2滲漏4椎。椎體周圍滲漏11椎、椎管內(nèi)滲漏3椎、椎間孔內(nèi)滲漏1椎、椎間隙滲漏7椎、椎旁軟組織內(nèi)滲漏2椎、混合型滲漏5椎(椎體周圍滲漏合并椎管內(nèi)滲漏2椎,椎體周圍滲漏合并椎間隙滲漏3椎)。發(fā)生椎管內(nèi)滲漏的3例患者出現(xiàn)胸背痛伴束帶感等臨床癥狀; 其中2例癥狀較重,急診行椎板減壓術(shù)治療; 1例經(jīng)非手術(shù)治療后癥狀緩解。1例患者發(fā)生硬膜外血腫壓迫脊髓,經(jīng)非手術(shù)治療后癥狀緩解。②鄰椎骨折情況。術(shù)后7椎并發(fā)鄰椎骨折,其中3椎有椎間隙滲漏; 11椎并發(fā)非鄰椎骨折。并發(fā)骨水泥椎間隙滲漏椎體的鄰椎骨折發(fā)生率高于未并發(fā)骨水泥椎間隙滲漏椎體(χ2=20.290,P=0.000)。③其他并發(fā)癥。5例后期并發(fā)股骨頸骨折; 3例患者術(shù)后出現(xiàn)短暫呼吸費力,肺部CT未見明顯骨水泥栓塞; 24例患者術(shù)后出現(xiàn)短暫性發(fā)熱,體溫均低于38.5 ℃,經(jīng)對癥處理后恢復正常。結(jié)論:骨水泥滲漏是經(jīng)皮椎體后凸成形術(shù)的主要并發(fā)癥,大多數(shù)骨水泥滲漏無需處理。椎管內(nèi)滲漏和椎間孔滲漏可壓迫脊髓和神經(jīng)根,需急診行椎板減壓術(shù)治療; 鄰椎繼發(fā)骨折可能與骨水泥椎間隙滲漏有關(guān)。

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備注/Memo

備注/Memo:
通訊作者:倪文飛 E-mail:[email protected]
更新日期/Last Update: 2014-03-20