中国修复重建外科杂志

中国修复重建外科杂志

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

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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:T 12、L 1 3 例,L 1、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 mL,平均 48 mL。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。

Objective To evaluate the feasibility and safety of percutaneous endoscopic technique in the treatment of intraspinal cement leakage after percutaneous vertebroplasty (PVP). Methods Between May 2014 and March 2016, 5 patients with lower limb pain and spinal cord injury caused by intraspinal cement leakage after PVP, were treated with percutaneous endoscopic spinal decompression. Of 5 cases, 3 were male and 2 were female, aged from 65 to 83 years (mean, 74.4 years). The course of disease was 10-30 days (mean, 16.2 days). Imageological examinations confirmed the levels of cement leakage at T 12, L 1 in 3 cases, and at L 1, 2 in 2 cases; bilateral sides were involved in 1 case and unilateral side in 4 cases. Two patients had lower limb pain, whose visual analogue scale (VAS) were 8 and 7; 3 patients had lower extremities weakness, whose Japanese Orthopedic Association (JOA) 29 scores were 18, 20, and 19. According to American Spinal Injury Association (ASIA) impairment scale, neural function was rated as grade E in 2 cases and grade D in 3 cases. Results The operation time was 55-119 minutes (mean, 85.6 minutes), and the blood loss was 30-80 mL (mean, 48 mL). CT scan and three-dimensional (3D) reconstruction at 1 day after operation showed that cement leakage was removed in all patients. Five cases were followed up 6-21 months (mean, 12 months). In 2 patients with lower limb pain, and VAS score was significantly decreased to 2 at last follow-up. In 3 patients with lower extremities weakness, the muscle strength was improved progressively, and the JOA29 scores at last follow-up were 21, 23, and 22. Conclusion Percutaneous endoscopic technique for intraspinal cement leakage after PVP is safe, effective, and feasible.

关键词: 经皮脊柱内镜技术; 经皮椎体成形术; 骨水泥椎管内渗漏; 脊髓损伤

Key words: Percutaneous endoscopic technique; percutaneous vertebroplasty; intraspinal cement leakage; spinal cord injury

引用本文: 于庆帅, 陈亮, 晏铮剑, 楚磊, 石磊, 邓忠良. 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. 中国修复重建外科杂志, 2017, 31(6): 690-695. doi: 10.7507/1002-1892.201612139 复制

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1. Galibert P, Deramond H, Rosat P, et al. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie, 1987, 33(2): 166-168.
2. Burton AW, Mendoza T, Gebhardt R, et al. Vertebral compression fracture treatment with vertebroplasty and kyphoplasty: experience in 407 patients with 1,156 fractures in a tertiary cancer center. Pain Med, 2011, 12(12): 1750-1757.
3. Bonnard E, Foti P, Kastler A, et al. Percutaneous vertebroplasty under local anaesthesia: feasibility regarding patients’ experience. Eur Radiol, 2017, 27(4): 1512-1516.
4. La Maida GA, Giarratana LS, Acerbi A, et al. Cement leakage: safety of minimally invasive surgical techniques in the treatment of multiple myeloma vertebral lesions. Eur Spine J, 2012, 21 Suppl 1: S61-S68.
5. Corcos G, Dbjay J, Mastier C, et al. Cement leakage in percutaneous vertebroplasty for spinal metastases: a retrospective evaluation of incidence and risk factors. Spine (Phlia Pa 1976), 2014, 39(5): E332-E338.
6. Nieuwenhuijse MJ, Van Erkel AR, Dijkstra PD. Cement leakage in percutaneous vertebroplasty for osteoporotic vertebral compression fractures: identification of risk factors. Spine J, 2011, 11(9): 839-848.
7. Tomé-Bermejo F, Piñera AR, Duran-Álvarez C, et al. Identification of Risk Factors for the Occurrence of Cement Leakage During Percutaneous Vertebroplasty for Painful Osteoporotic or Malignant Vertebral Fracture. Spine, 2013, 9(Supplement): S90.
8. Saracen A, Kotwica Z. Complications of percutaneous vertebroplasty: An analysis of 1100 procedures performed in 616 patients. Medicine (Baltimore), 2016, 95(24): e3850.
9. Kulkarni AG, Shah SP, Deopujari CE. Epidural and intradural cement leakage following percutaneous vertebroplasty: a case report. J Orthop Surg (Hong Kong), 2013, 21(3): 365-368.
10. Al-Nakshabandi NA. Percutaneous vertebroplasty complications. Ann Saudi Med, 2013, 31(3): 294-297.
11. Fehlings MG, Perrin RG. The timing of surgical intervention in the treatment of spinal cord injury: a systematic review of recent clinical evidence. Spine (Phlia Pa 1976), 2006, 31(11 Suppl): S28-35.
12. Vaccaro AR, Daugherty RJ, Sheehan TP, et al. Neurologic outcome of early versus late surgery for cervical spinal cord injury. Spine (Phlia Pa 1976), 1997, 22(22): 2609-2613.
13. 周方. 胸腰椎骨折伴完全性脊髓损伤的手术时机选择. 中华创伤杂志, 2015, 31(6): 490.
14. Fehlings MG, Perrin RG. The role and timing of early decompression for cervical spinal cord injury: update with a review of recent clinical evidence. Injury, 2005, 36 Suppl 2: B13-26.
15. Lin BJ, Li CC, Ma HI. Intradural Cement Leakage After Percutaneous Vertebroplasty. Turk Neurosurg, 2015, 25(6): 940-942.
16. 施建党, 白雷, 丁惠强, 等. 不同术式治疗陈旧性胸腰椎骨折并脊髓损伤的疗效比较. 中国修复重建外科杂志, 2008, 22(11): 1327-1329.
17. Wu AM, Zheng YJ, Lin Y, et al. Transforaminal decompression and interbody fusion in the treatment of thoracolumbar fracture and dislocation with spinal cord injury. PloS One, 2014, 9(8): e105625.
18. Ruetten S, Komp M, Merk H, et al. Recurrent lumbar disc herniation after conventional discectomy: a prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision. J Spinal Disord Tech, 2009, 22(2): 122-129.
19. Ahn Y. Percutaneous endoscopic decompression for lumbar spinal stenosis. Expert Rev Med Devices, 2014, 11(6): 605-616.
20. Li ZZ, Hou SX, Shang WL, et al. Percutaneous lumbar foraminoplasty and percutaneous endoscopic lumbar decom-pression for lateral recess stenosis through transforaminal approach: Technique notes and 2 years follow-up. Clin Neurol Neurosurg, 2016, 143: 90-94.
21. Yeom JS, Kim WJ, Choy WS, et al. Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteo-porotic compression fractures. J Bone Joint Surg (Br), 2003, 85(1): 83-89.
22. Ahn SS, Kim SH, Kim DW. Learning Curve of Percutaneous Endoscopic Lumbar Discectomy Based on the Period (Early vs. Late) and Technique (in-and-out vs. in-and-out-and-in): A Retrospective Comparative Study. J Korean Neurosurg Soc, 2015, 58(6): 539-546.