【摘要】 [目的]探讨经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗胸腰椎体压缩性骨折(osteoporotic vertebral compression fractures,OVCFs)与转移性肿瘤的并发症,分析发生原因及防治对策。[方法]回顾分析本院2005年7月~2014年12月行椎体成形术治疗的240例单节段胸腰椎骨折患者147例,年龄65~92岁,平均(65.4±16.5)岁;转移性肿瘤93例,年龄31~79岁,平均(51.6±14.7)岁。随访6个月~1年,平均8.8个月。记录骨折组与肿瘤组患者手术前后视觉疼痛评分(visual analogue scale,VAS)及并发症情况。[结果]240例椎体成形术患者,共发生并发症72例(30%),其中转移性肿瘤患者41例(44%),压缩性骨折患者31例(21%)。骨折组患者术前、术后1 d、术后1、3个月VAS评分分别为(7.36±1.28)分、(1.37±0.98)分、(2.87±0.48)分、(2.93±0.56)分。肿瘤组患者术前、术后1 d,术后1、3个月VAS评分分别为(7.86±3.35)分、(2.85±0.78)分、(2.88±3.55)分、(4.93±0.89)分。两组术前、术后1 d、术后1个月评分比较差异无统计学意义,术后3个月评分差异均有统计学意义(P<0.05)。并发症:术中推注骨水泥时一过性血压下降6例;骨水泥渗漏30例;术后发热5例;术后自觉疼痛加重5例;1例胃癌转移性肿瘤患者术后出现昏迷,经查为高钙血症。术后3个月内邻近节段再骨折25例。[结论]对骨折和骨肿瘤应用椎体成形术治疗有一定的并发症。转移性肿瘤患者并发症发生率相对较高。总结经验,提高手术技术能有效降低并发症的发生率。更多还原

【Abstract】 [Objective]To compare the complications caused by percutaneous vertebroplasty( PVP) for osteoporotic vertebral compression fractures( OVCFs) and spinal metastasis,and investigate the prevention strategies. [Method]From July 2005 to December 2014,a total of 240 vertebrae in 240 patients( aged from 31 to 92 years) with OVCFs( 147 patients,65- 92 years old,mean 65. 4 ± 16. 5 years) or spinal metastasis( 93 patients,31- 79 years old,mean 51. 6 ± 14. 7 years) underwent PVP. All patients were followed up for an average of 8. 8 months( range,6- 12 months). The differences in pre- and postoperative visual analogue scales( VAS) and postoperative complications between OVCFs group and spinal metastasis group were compared.[Result]Complications were noted in 72 cases in all 240 cases( 30%),with 41 cases of spinal metastasis( 41 /93,44%) and31 cases of OVCFs( 31 /147,21%). In OVCFs group,VAS before surgery,at 1 day,1 month and 3 months after surgery were 7.36 ± 1. 28,1. 37 ± 0. 98,± 2. 87 ± 0. 48,± 2. 93 ± 0. 56,respectively. In metastasis group,the results were 7. 86 ± 3. 35,2. 85 ±0. 78,± 2. 88 ± 3. 55,4. 93 ± 0. 89,respectively. The results of VAS in OVCFs patients were significantly better than those in spinal metastasis patients( P < 0. 05). In all patients,bone cement leakage were noted in 30 cases,5 cases had transient hypertension,5 cases had postoperative fever,5 cases had aggravation of pain,another patient was found coma after operation due to hypercalcemia. Fresh refracture was found in 25 patients in adjacent vertebrae within 3 months after operation. [Conclusion]The rate of complications in spinal metastasis patients is higher than that in OVCFs patients. It is important to sum up experiences and improve surgical technique to decrease the occurrence of complications.更多还原