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目的：探讨经皮椎体增强术（PVA）后神经损伤的发生率，并分析其影响因素。方法：回顾性分析2017年1月至2022年12月于南京医科大学附属泰州人民医院接受PVA治疗的1 847例患者的临床资料。收集患者年龄、性别、骨折原因、骨折至手术时间；记录骨折部位、手术节段及手术节段数、穿刺路径、手术方式；分析聚甲基丙烯酸甲酯（PMMA）渗漏发生情况以及PVA术后神经功能状态。结果：本研究共纳入1 847例患者，其中男422例（22.8%），女1 425例（77.2%），共2 319个病椎。患者年龄38～93岁，平均（70.71±8.80）岁，其中211例（11.4%）患者年龄在60岁及以下，1 636例（88.6%）患者年龄在60岁以上。46例（2.5%）患者（67个病椎）因肿瘤性椎体骨折（NVF）接受手术，其余1 801例（97.5%）患者（2 252个病椎）因骨质疏松性椎体压缩骨折（OVCF）接受手术。1 781个（76.8%）病椎接受经皮椎体成形术（PVP），其余538个（23.2%）病椎接受经皮椎体后凸成形术（PKP）。478个（20.6%）病椎接受单侧穿刺，其余1 841个（79.4%）病椎接受双侧穿刺。术后X线检查显示，403个（17.4%）病椎出现PMMA渗漏。在1 847例患者中，6例患者术后出现神经损伤症状，PVA术后神经损伤的发生率为0.32%。6例患者中，4例出现PMMA渗漏，2例术中发生穿刺损伤。NVF患者PVA术后神经损伤发生率高于OVCF患者（2.17%vs. 0.28%），差异有统计学意义（P=0.026）。结论：PVA是一种有效且微创的手术方法，可用于治疗OVCF和NVF。然而，PVA可能导致严重的神经损伤，与OVCF患者相比，NVF患者PVA术后神经损伤的风险更高。
Abstract：Objective: To investigate the incidence of neurological injury after percutaneous vertebral augmentation(PVA) and analyze its influencing factors. Methods: A retrospective analysis was conducted on the clinical data of 1,847 patients who underwent PVA treatment at the Affiliated Taizhou People's Hospital of Nanjing Medical University from January 2017 to December 2022. Patients' age, gender, fracture cause, and time from fracture to surgery were collected; the fracture site, surgical segments and number of surgical segments, puncture approach, and surgical method were recorded; the occurrence of polymethylmethacrylate(PMMA) leakage and neurological function status after PVA were analyzed. Results: A total of 1,847 patients(422 males, 22.8%; 1,425 females, 77.2%) involving 2, 319 affected vertebrae were included. The mean age was 70.71±8.80 years(range, 38 – 93 years). Of these, 211 patients(11.4%) were ≤60 years, and 1, 636 patients(88.6%) were >60 years. Forty-six patients(2.5%; 67 vertebrae) underwent surgery for neoplastic vertebral fractures(NVF), while the remaining 1, 801 patients(97.5%; 2, 252 vertebrae) were treated for osteoporotic vertebral compression fractures(OVCF). Percutaneous vertebroplasty(PVP) was performed in 1, 781 vertebrae(76.8%), and percutaneous kyphoplasty(PKP) was performed in the remaining 538 vertebrae(23.2%). Postoperative X-ray examination unilateral puncture was performed in 478 vertebrae(20.6%) and bilateral puncture in 1, 841 vertebrae(79.4%) showed that PMMA leakage occurred in 403 vertebrae(17.4%). Among the 1,847 patients, 6 patients developed neurological injury after surgery, and the incidence of neurological injury after PVA was 0.32%. Of these 6 patients, 4 cases were associated with PMMA leakage, and 2 were attributed to intraoperative puncture injury. The incidence of neurological injury was significantly higher in NVF than in OVCF(2.17% vs. 0.28%), and the difference was statistically significant(P=0.026). Conclusions: PVA is an effective and minimally invasive procedure for OVCF and NVF, but it carries a risk of severe neurological injury. Patients with NVF are at higher risk of postoperative neurological injury compared with those with OVCF.
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基本信息:
DOI：
中图分类号:R687.3
引用信息:
[1]朱先洋,黄鸿,王昭瑞等.经皮椎体增强术后神经损伤的发生率及其影响因素分析[J].中华骨与关节外科杂志,2025,18(09):795-801.
基金信息:
南京医科大学科技发展基金（NMUB20230298）