经皮椎体成形术治疗骨质疏松性椎体骨折并发无症状性肺栓塞1例

2017-11-20 佚名 生物骨科材料与临床研究

患者老年女性、74岁、回族,搀扶老伴起床时突感胸背部疼痛5天后入院。

【一般资料】

患者老年女性、74岁、回族

【主诉】

搀扶老伴起床时突感胸背部疼痛5天后入院。

【既往史】

既往患有糖尿病、颈椎病、腰椎管狭窄症、多发性脑梗塞等慢性疾病史;50岁绝经。

【体格检查】

一般情况良好,心肺腹无异常,专科查体胸腰段轻度后凸畸形,T10-12椎体棘突压痛明显,无双下肢神经症状,患者主要为翻身疼痛明显,站立行走疼痛可忍受,影响日常生活。

【辅助检查】

入院后完善各项检查,行胸腰椎MRI检查(图1)明确诊断为T10椎体骨折、骨髓水肿;



【治疗】

入院后第5天在局麻下行T10椎体成形术,术中定位、穿刺等操作顺利,手术历时30分钟,手术过程中患者除穿刺时有疼痛主诉外无任何不适反应,注入骨水泥过程中发现椎体前缘血管渗漏立即终止手术,询问患者无不适,待水泥凝固后拔出工作套管,C臂透视显示椎体前缘有血管影,椎体后方无渗漏,送患者回病房,心电监护、密切监测生命体征24小时,患者无不适,术后疼痛立刻缓解,可自由翻身,术后第1日带腰围下地行走,常规使用抗骨质疏松治疗3天出院(静脉滴注唑来膦酸钠5mg:100mL),出院前复查术后X光片(图4)发现双肺多发散在毛细血管显影,考虑为骨水泥渗漏、肺栓塞,出院后跟踪电话随访患者无肺部症状,考虑为无症状性骨水泥肺栓塞。继续追踪随访。本例患者虽未造成严重不良后果,但我们应该高度重视此并发症,一旦发生严重事件,后果不堪设想,故撰写此文,以提醒广大脊柱外科同行,以免发生不可挽回的损失。


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    2018-10-30 丁鹏鹏
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time=2017-11-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1592423, encodeId=c1a7159242365, content=<a href='/topic/show?id=6dc2101853ed' target=_blank style='color:#2F92EE;'>#骨质#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101853, encryptionId=6dc2101853ed, topicName=骨质)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e1d018108513, createdName=Eleven17, createdTime=Wed Nov 22 03:09:00 CST 2017, time=2017-11-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=262843, encodeId=71bb262843cf, content=学习了.好文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Mon Nov 20 13:15:10 CST 2017, time=2017-11-20, status=1, ipAttribution=)]
    2018-02-09 1e145228m78(暂无匿称)

    学习了.谢谢作者分享!

    0

  5. 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  6. 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style='color:#2F92EE;'>#椎体#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62835, encryptionId=708a6283509, topicName=椎体)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=930e243, createdName=dingxiaobo, createdTime=Wed Nov 22 03:09:00 CST 2017, time=2017-11-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1484983, encodeId=158c1484983e3, content=<a href='/topic/show?id=4bbe5902ed2' target=_blank style='color:#2F92EE;'>#无症状#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59027, encryptionId=4bbe5902ed2, topicName=无症状)], attachment=null, authenticateStatus=null, createdAvatar=Bioon/avatar/20180429/70baad2aa5a046c5aa2914d262de7d37.jpg, createdBy=bd077990475, createdName=12498da4m34(暂无昵称), createdTime=Wed Nov 22 03:09:00 CST 2017, time=2017-11-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1592423, encodeId=c1a7159242365, content=<a href='/topic/show?id=6dc2101853ed' target=_blank style='color:#2F92EE;'>#骨质#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101853, encryptionId=6dc2101853ed, topicName=骨质)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e1d018108513, createdName=Eleven17, createdTime=Wed Nov 22 03:09:00 CST 2017, time=2017-11-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=262843, encodeId=71bb262843cf, content=学习了.好文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Mon Nov 20 13:15:10 CST 2017, time=2017-11-20, status=1, ipAttribution=)]
    2017-11-22 dingxiaobo
  7. 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  8. 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createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Mon Nov 20 13:15:10 CST 2017, time=2017-11-20, status=1, ipAttribution=)]
    2017-11-22 Eleven17
  9. 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createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Mon Nov 20 13:15:10 CST 2017, time=2017-11-20, status=1, ipAttribution=)]
    2017-11-20 1ddf0692m34(暂无匿称)

    学习了.好文章

    0

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