后路翻修术治疗PVP后并发椎管内骨水泥渗漏伴脊髓损伤

发布时间：2018-03-25 13:01

本文选题：胸腰椎　切入点：骨质疏松骨折　出处：《中国矫形外科杂志》2017年14期

【摘要】：[目的]探讨后路手术治疗胸腰椎骨质疏松骨折经皮椎体成形术(PVP)并发椎管内骨水泥渗漏所致脊髓损伤的临床效果。[方法]回顾性分析2013年7月~2016年7月收治4例胸腰椎骨质疏松性压缩性骨折PVP治疗后并发椎管内骨水泥渗漏所致脊髓损伤患者的临床资料,院外转入3例、本院1例,均为女性,年龄65~75岁,平均70岁。发生在T111例、T122例、L11例,骨水泥渗漏至椎管内硬脊膜外3例、硬脊膜内1例,4例患者均有不同程度的胸腰背部及双下肢疼痛、腹部束带感、双下肢肌力下降、感觉减退等脊髓损伤表现。4例患者翻修均采取后路全椎板切除减压、经椎弓根截骨取出骨水泥、椎间植骨支撑、后方长节段内固定术。术后随访12~22个月,平均18个月,通过观察脊髓功能恢复情况、疼痛缓解程度、椎间骨性融合情况等判定其疗效。[结果]渗漏至硬脊膜外3例患者翻修术后临床症状完全缓解,渗漏至硬脊膜内的1例患者仍遗留排尿困难及双下肢疼痛,但肌力已恢复至IV级。4例患者均获得18个月随访,未见内固定物松动、脱出,椎间骨性融合良好。[结论]后路手术治疗PVP并发椎管内骨水泥渗漏所致脊髓损伤减压彻底、骨水泥取出方便安全、椎间植骨支撑后方长节段内固定更加符合胸腰椎骨质疏松性骨折内固定生物力学,临床疗效满意。
[Abstract]:[objective] to investigate the clinical effect of posterior approach in the treatment of spinal cord injury caused by percutaneous vertebroplasty (PVP) of thoracolumbar osteoporotic fracture and the leakage of bone cement in spinal canal. [methods] retrospective analysis was made on 4 cases of spinal cord injury caused by percutaneous vertebroplasty and PVP from July 2013 to July 2016. Clinical data of patients with spinal cord injury caused by bone cement leakage in spinal canal after PVP treatment for osteoporotic compression fracture of thoracolumbar vertebrae. 3 cases were transferred out of hospital, 1 case was female, the age was 6575 years old with an average age of 70 years, 11 cases occurred in T111 cases with T122 cases, and 3 cases with bone cement leakage into the epidural space of the spinal canal. In 1 case of dural spinal cord injury, 4 cases had different degree of pain in thoracolumbar back and lower extremity, abdominal band sense, lower limb muscle strength, hypoaesthesia and other spinal cord injuries. 4 cases of spinal cord injury were treated with posterior total laminectomy and decompression. Bone cement was removed by pedicle osteotomy, intervertebral bone graft was supported, and posterior long segment internal fixation was performed. The postoperative follow-up ranged from 12 to 22 months (mean 18 months). The recovery of spinal cord function and the degree of pain relief were observed. Intervertebral osseous fusion was used to evaluate the curative effect. [results] the clinical symptoms of 3 patients with extradural leakage were completely relieved after revision, and one patient with leakage to the epidural remained dysuria and lower extremity pain. But the muscle strength had recovered to grade IV, all the patients were followed up for 18 months. There was no loosening of internal fixation, no prolapse and good fusion of intervertebral bone. [conclusion] posterior approach for decompression of spinal cord injury caused by PVP complicated with cement leakage in spinal canal is complete. The removal of bone cement is convenient and safe, and the internal fixation of long segment behind intervertebral bone graft support is more in line with the biomechanics of thoracolumbar osteoporotic fracture, and the clinical effect is satisfactory.
【作者单位】：重庆市开州区人民医院骨科;
【分类号】：R651.2;R687.3

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