Early clinical outcome and complications related to balloon kyphoplasty.
Early clinical outcome and complications related to balloon kyphoplasty.
复制标题
DOI：
10.4081/or.2012.e25
复制
发表时间：
2012-05-09
影响因子：
2.1
通讯作者：
Krüger A
中科院分区：
文献类型：
--
作者：
Bergmann M;Oberkircher L;Bliemel C;Frangen TM;Ruchholtz S;Krüger A
在过去的二十年里，使用经椎弓根骨水泥加固治疗疼痛性椎体压缩性骨折有了显著增长。球囊椎体后凸成形术与保守治疗相比的受益仍存在争议，并在文献中进行了讨论。认为椎体成形术和椎体后凸成形术的并发症发生率较低。本研究的重点是分析与该手术相关的急性和临床相关并发症。在我科，前瞻性记录了2002年2月至2011年2月期间接受经皮骨水泥强化治疗的所有患者（372例患者，522个强化椎体）。记录人口统计学数据、合并症、骨折类型、术中数据和所有并发症。评价术前、术后疼痛程度和神经功能状态（Frankel评分）。所有患者均接受了标准化的外科手术。297例患者仅接受球囊椎体后凸成形术治疗; 216例女性（72.7%）和81例男性（27.3%）。患者平均年龄为76.21岁（±10.71，范围35-98岁）。美国社会麻醉学家的平均得分为3.02。根据骨科创伤协会分类，有69例A1.1骨折，177例A1.2骨折，178例A3.1.1骨折和3例A3.1.3骨折。并发症分为术前、术中和术后事件。有4例术前并发症：3例患者术后出现持续疼痛。在1例病例中，手术期间无法观察到椎弓根，手术终止。129例（40.06%）患者显示术中骨水泥泄漏到椎体外，1例严重低血压和心动过速作为对球囊充盈的反应，1例术中心脏骤停。术后皮下血肿3例，尿路感染13例，住院期间死亡2例。24例患者（8.1%）因新发疼痛事件返回，23例患者报告新发疼痛性骨折。球囊椎体后凸成形术是治疗疼痛性椎体压缩骨折患者的一种安全有效的手术。椎体后凸成形术后患者可以快速活动，并迅速重新融入社会环境。与其他外科手术相比，尤其是在平均年龄为75岁的患者中，球囊椎体后凸成形术似乎具有一些优势。然而，该手术仍有可能发生严重并发症，应由训练有素的人员进行。
The treatment of painful osteoporotic vertebral compression fractures using transpedicular cement augmentation has grown significantly over the last two decades. The benefits of balloon kyphoplasty compared to conservative treatment remain controversial and are discussed in the literature. The complication rates of vertebroplasty and kyphoplasty are considered to be low. The focus of this study was the analysis of acute and clinically relevant complications related to this procedure. In our department, all patients treated between February 2002 and February 2011 with percutaneous cement augmentation (372 patients, 522 augmented vertebral bodies) were prospectively recorded. Demographic data, comorbidities, fracture types, intraoperative data and all complications were documented. The pre- and postoperative pain-level and neurological status (Frankel-Score) were evaluated. All patients underwent a standardized surgical procedure. Two hundred and ninety-seven patients were treated solely by balloon kyphoplasty; 216 females (72.7%) and 81 males (27.3%). Average patient age was 76.21 years (±10.71, range 35–98 years). Average American Society Anestesiologists score was 3.02. According to the Orthopedic Trauma Association classification, there were 69 A 1.1 fractures, 177 A 1.2 fractures, 178 A 3.1.1 fractures and 3 A 3.1.3 fractures. Complications were divided into preoperative, intraoperative and postoperative events. There were 4 preoperative complications: 3 patients experienced persistent pain after the procedure. In one case, the pedicles could not be visualized during the procedure and the surgery was terminated. One hundred and twenty-nine (40.06%) of the patients showed intraoperative cement leaking outside the vertebras, one severe hypotension and tachycardia as reaction to the inflation of the balloons, and there was one cardiac arrest during surgery. Postoperative subcutaneous hematomas were observed in 3 cases, 13 patients developed a urinary tract infection, and 2 patients died during hospitalization. Twenty-four patients (8.1%) returned because of new pain events and 23 patients reported a new painful fracture. Balloon kyphoplasty is a save and effective procedure to treat patients with painful vertebral compression fractures. Rapid patient mobilization after kyphoplasty, as well as a prompt reintegration into the social environment, are possible. Compared to other surgical procedures, especially in patients with an average age of 75 years, balloon kyphoplasty seems to offer some advantages. However, the procedure still has a potential for serious complications and should be performed by well trained personnel.