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.
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。.
Keywords: Percutaneous endoscopic technique; intraspinal cement leakage; percutaneous vertebroplasty; spinal cord injury.