[1]于东方,王祥善,张华,等.经皮椎体成形术后手术椎体再骨折的病因、治疗及预防[J].中医正骨,2018,30(10):69-73.
点击复制

经皮椎体成形术后手术椎体再骨折的病因、治疗及预防()
分享到:

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期数:
2018年10期
页码:
69-73
栏目:
临床报道
出版日期:
2018-10-20

文章信息/Info

作者:
于东方王祥善张华曹顺海
(河南省郑州市骨科医院,河南 郑州 450052)
关键词:
骨质疏松性骨折 脊柱骨折 椎体成形术 手术后并发症 再骨折
摘要:
目的:探讨经皮椎体成形术(percutaneous vertebroplasty,PVP)后手术椎体再骨折的病因、治疗方法及预防措施。方法:2013年8月至2016年8月收治15例PVP术后手术椎体再骨折患者。第1次手术病因均为骨质疏松加轻微外力损伤致椎体压缩骨折,均采用单侧穿刺PVP治疗。初次手术至此次入院时间为1周至1年,中位数4个月。15例均表现为腰背及腰骶部缓解的疼痛再次发作,休息难以缓解,其中1例症状仅表现在第1次手术对侧,1例伴有会阴区麻木及下肢神经受压症状。与第1次手术最后一次复查时相比,X线检查显示9例未见原手术椎体高度明显丢失、6例原手术椎体高度轻度丢失,MRI检查T1WI、T2WI均显示原手术椎体内异常信号不同程度加重。此次入院后采用视觉模拟量表(visual analogue scale,VAS)评定疼痛程度,3例VAS评分<3分者行非手术治疗,12例VAS评分≥3分者行手术治疗,其中11例经第1次手术对侧穿刺行PVP手术,1例伴有会阴区麻木及下肢神经受压症状者,行后路切开复位骨水泥清除植骨钉棒内固定治疗。结果:3例采用非手术治疗者,经1~2周住院治疗后疼痛明显缓解(VAS评分1分),生活完全自理。11例再次行PVP手术治疗者,住院3~5 d,每个椎体注入骨水泥2~3.5 mL,其中3例骨水泥经椎间隙少量渗漏,未出现神经损伤症状; 术后6例疼痛完全缓解(VAS评分0分),3例疼痛部分缓解(VAS评分2分),2例需口服非甾体类抗炎药(VAS评分2分),生活均可自理。行后路切开复位骨水泥清除植骨钉棒内固定术治疗的患者,术后会阴区麻木及下肢神经受压症状均明显改善,配合口服非甾体类抗炎药,患者对治疗效果满意。结论:PVP术后手术椎体再骨折是多个相关危险因素综合作用的结果,应从多个方面着手进行预防,治疗时应仔细评估患者的具体情况,采用非手术、再次PVP手术或开放手术治疗。

参考文献/References:


[1] 余鹏,夏群,皮红林,等.经皮椎体成形术后相邻椎体再骨折的相关因素[J].中华创伤杂志,2013,29(11):1063-1067.
[2] 陈萌萌,贾璞,陈浩,等.骨水泥强化术后手术椎体再骨折的研究进展[J].中华创伤骨科杂志,2015,17(12):1101-1104.
[3] LI X,LOU X,LIN X,et al.Refracture of osteoporotic vertebral body concurrent with cement fragmentation at the previously treated vertebral level after balloon kyphoplasty:a case report[J].Osteoporos Int,2014,25(5):1647-1650.
[4] SUMMA A,CRISI G,CERASTI D,et al.Refractures in cemented vertebrae after percutaneous vertebroplasty and pain relief after a second procedure:a retrospective analysis[J].Neuroradiol J,2009,22(2):239-243.
[5] CHEN LH,HSIEH MK,LIAO JC,et al.Repeated percutaneous vertebroplasty for refracture of cemented vertebrae[J].Arch Orthop Trauma Surg,2011,131(7):927-933.
[6] SUN G,TANG H,LI M,et al.Analysis of risk factors of subsequent fractures after vertebroplasty[J].Eur Spine J,2014,23(6):1339-1345.
[7] UPPIN AA,HIRSCH JA,CENTENERA LV,et al.Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis[J].Radiology,2003,226(1):119-124.
[8] 曹珺,刘纪恩,母心灵,等.PVP/PKP术后手术椎体再骨折的治疗[J].中国脊柱脊髓杂志,2014,10(10):950-952.
[9] 田伟,韩骁,刘波,等.经皮椎体后凸成形术后骨水泥分布与手术椎体再骨折的关系[J].中华创伤骨科杂志,2012,14(3):211-215.
[10] 覃裕,邱冰,朱思刚,等.骨质疏松性椎体压缩骨折椎体成形术后再骨折的影响因素分析[J].中华创伤杂志,2016,32(9):799-801.
[11] 王晶,陈民,杜江.经皮椎体成形术后骨水泥强化椎再骨折的保守治疗及疗效分析[J].南方医科大学学报,2016,36(2):277-281.
[12] 王伟,万雷,柴爽,等.骨质疏松症的中医病因病机和分期治疗[J].中医正骨,2018,30(2):29-30.
[13] HE SC,TENG GJ,DENG G,et al.Repeat vertebroplasty for unrelieved pain at previously treated vertebral levels with osteoporotic vertebral compression fractures[J].Spine(Phila Pa 1976),2008,33(6):640-647.
[14] 彭立军,羊明智,刘骞,等.单侧PVP术后致对侧发生骨折的临床分析[J].颈腰痛杂志,2016,36(6):470-473.
[15] 陈建德,樊晓琦,夏炳江,等.球囊扩张部位对椎体后凸成形术治疗骨质疏松性椎体压缩骨折疗效及安全性的影响[J].中医正骨,2017,29(2):11-16.
[16] KIM YY,RHYU KW.Recompression of vertebral body after balloon kyphoplasty for osteoporotic vertebral compression fracture[J].Eur Spine J,2010,19(11):1907-1912.
[17] 李建赤,黄必留,谭加群,等.高黏度骨水泥经皮椎体成形术治疗骨质疏松性椎体压缩骨折的临床研究[J].中华骨与关节外科杂志,2016,9(4):317-321.

相似文献/References:

[1]张亮,张莉,王莉佳,等.快速康复外科理念在椎弓根螺钉内固定治疗 胸腰椎骨折围手术期护理中的应用[J].中医正骨,2015,27(06):75.
[2]潘雄,刘其顺,应行,等.中药联合4步康复锻炼法对骨质疏松性椎体压缩 骨折患者生存质量的影响[J].中医正骨,2015,27(04):65.
[3]宋永枝,陈双玲.唑来膦酸静脉滴注联合鲑降钙素肌肉注射治疗 骨质疏松性长骨骨折[J].中医正骨,2016,28(01):70.
[4]孙兰芬,王龙强,刘润宏,等.颈椎骨折脱位合并脊髓损伤截瘫患者的围手术期护理[J].中医正骨,2016,28(03):79.
[5]吴鹏,王博,孔令成,等.强骨饮颗粒联合阿仑膦酸钠维D3片口服在原发性骨质疏松性髋部骨折术后抗骨质疏松治疗中的应用[J].中医正骨,2016,28(05):16.
 WU Peng,WANG Bo,KONG Lingcheng,et al.Oral application of Qiangguyin Keli(强骨饮颗粒)and alendronate sodium Vitamin D3 tablets in postoperative anti-osteoporosis treatment in patients with primary osteoporotic hip fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(10):16.
[6]梅 伟.胸腰椎骨折临床诊疗中的热点问题[J].中医正骨,2016,28(07):1.
[7]徐无忌,刘晓岚.体位复位结合经皮椎体成形术与经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的对比研究[J].中医正骨,2016,28(07):20.
 XU Wuji,LIU Xiaolan.Effect of Qianggu Yin(强骨饮,QGY)on bone microstructure in the ovariectomized osteoporosis rats[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(10):20.
[8]李英周,叶锋,王晓,等.后路撬拨植骨椎弓根螺钉内固定治疗胸腰椎骨折[J].中医正骨,2016,28(07):46.
[9]王军,陈哲,王硕凡.胸腰椎骨折椎体植骨材料的临床应用进展[J].中医正骨,2016,28(07):64.
[10]史晓林,王健,王博,等.脆性骨折的防治进展[J].中医正骨,2017,29(05):20.
[11]陈建德,樊晓琦,夏炳江,等.球囊扩张部位对椎体后凸成形术治疗骨质疏松性椎体压缩骨折疗效及安全性的影响[J].中医正骨,2017,29(02):11.
 CHEN Jiande,FAN Xiaoqi,XIA Bingjiang,et al.Influence of balloon dilation position on curative effect and safety of percutaneous kyphoplasty for treatment of osteoporotic vertebral compression fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(10):11.
[12]丁志清,颜峰,喻灿明,等.椎体后凸成形术后非典型骨水泥植入综合征死亡1例[J].中医正骨,2017,29(11):76.
[13]俞兴,王婷,杨济洲,等.经皮椎体成形术和经皮椎体后凸成形术治疗Kmmell病的对比研究[J].中医正骨,2018,30(06):23.
 YU Xing,WANG Ting,YANG Jizhou,et al.A retrospective trial of percutaneous vertebroplasty versus percutaneous kyphoplasty for treatment of Kmmell's diseases[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(10):23.
[14]彭小东,张晓刚,赵文韬,等.有限元分析在过伸复位治疗骨质疏松性椎体压缩性骨折生物力学研究中的应用进展[J].中医正骨,2018,30(07):25.
[15]陈建德,樊晓琦,凌义龙.单侧椎弓根旁外侧入路与双侧椎弓根入路 经皮椎体后凸成形术治疗骨质疏松性胸椎 压缩性骨折的对比研究[J].中医正骨,2018,30(10):19.
 CHEN Jiande,FAN Xiaoqi,LING Yilong.A retrospective trial of percutaneous kyphoplasty through unilateral extrapedicular approach versus bilateral transpedicular approach for treatment of thoracic osteoporotic vertebral compression fracture[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(10):19.
[16]李兆勇,杨少锋,张晨阳.补肾活血方联合经皮椎体强化术治疗骨质疏松性椎体压缩骨折的系统评价[J].中医正骨,2019,31(03):28.
 LI Zhaoyong,YANG Shaofeng,ZHANG Chenyang.Oral application of Bushen Huoxue Fang(补肾活血方)combined with percutaneous vertebral augmentation for treatment of osteoporotic vertebral compression fractures:a systematic review[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(10):28.

备注/Memo

备注/Memo:

通讯作者:王祥善 E-mail:13838076078@163.com
更新日期/Last Update: 2019-02-25