经皮脊柱内镜治疗经皮椎体成形术后骨水泥椎管内渗漏的疗效观察

发布时间：2018-07-18 12:39

【摘要】：目的探讨采用经皮脊柱内镜治疗经皮椎体成形术(percutaneous vertebroplasty,PVP)后骨水泥椎管内渗漏的可行性及安全性。方法 2014年5月—2016年3月,应用经皮脊柱内镜下椎管内骨水泥取出减压术治疗5例PVP术后骨水泥椎管内渗漏致脊髓神经损伤患者。其中,男3例,女2例;年龄65~83岁,平均74.4岁;PVP术后至该次入院时间为10~30 d,平均16.2 d。骨水泥渗漏节段:T12、L1 3例,L1、2 2例;双侧渗漏1例,单侧渗漏4例。主要临床症状为下肢疼痛2例,疼痛视觉模拟评分(VAS)分别为8分及7分;下肢肌力减退3例,日本骨科协会(JOA)29评分分别为18、20、19分。5例神经功能根据美国脊髓损伤协会(ASIA)损伤分级为E级2例,D级3例。结果手术时间55~119 min,平均85.6 min。术中出血量30~80 m L,平均48 m L。术后第1天影像学检查均示骨水泥均全部取出。5例患者均获得随访,随访时间6~21个月,平均12个月。其中,2例术前临床症状以下肢疼痛为主患者,末次随访时VAS评分均为2分;3例术前临床症状以下肢肌力减退为主患者,下肢肌力逐渐恢复,末次随访JOA29评分分别为21、23、22分。结论经皮脊柱内镜技术治疗PVP术后骨水泥椎管内渗漏安全、可行。
[Abstract]:Objective to investigate the feasibility and safety of percutaneous spinal endoscopy in the treatment of percutaneous vertebroplasty. Methods from May 2014 to March 2016, 5 cases of spinal cord nerve injury caused by bone cement leakage after PVP were treated with percutaneous endoscopic decompression. Among them, 3 cases were male and 2 cases were female, the age was 65 ~ 83 years old (mean 74.4 years) after PVP operation, the average time to be admitted to the hospital was 1030 days (16.2 days). There were 22 cases of bone cement leakage in 3 cases, 1 case of bilateral leakage and 4 cases of unilateral leakage. The main clinical symptoms were lower limb pain (2 cases), pain visual analogue score (VAS) of 8 and 7 points, lower extremity dyskinesia (3 cases), and visual analogue score (VAS) of lower extremity (VAS). The Japanese Orthopaedic Association (JOA) score of 29 was 18v 20, and the score of 19 cases was 5 cases. According to the American Spinal Cord injury Association (Asia), 2 cases were classified as Grade E and 3 cases as Grade D. Results the operative time was 55 minutes, 119 minutes, with an average of 85.6 minutes. The blood loss during operation was 30 ~ 80 mL (mean 48 mL). On the first day after operation, all the patients were followed up for 6 ~ 21 months (mean 12 months). There were 2 patients with lower extremity pain before operation and 3 patients with lower limb dyskinesia at the last follow-up. The lower limb muscle strength recovered gradually. The JOA29 score of the last follow-up was 21: 23 and 22 respectively. Conclusion Percutaneous spinal endoscopy is safe and feasible for the treatment of intramedullary leakage of bone cement after PVP.
【作者单位】：重庆医科大学附属第二医院骨科;
【基金】：重庆市卫生和计划生育委员会适宜卫生技术推广项目(2015jstg003、2016jstg018);重庆市卫生和计划生育委员会医学科研重点项目(2016ZDXM007) 重庆市科技平台研发专项基金(ctsc2015yfpt-gcjsyjzx120019)~~
【分类号】：R687.3

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