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Incidence and Clinical Risk of Cement Extravasation in Adult Patients Undergoing Prophylactic Vertebroplasty During Surgical Spine Reconstruction.

手术脊柱重建期间接受预防性椎体成形术的成人患者骨水泥外渗的发生率和临床风险。

  • 影响因子:1.52
  • DOI:10.1016/j.wneu.2019.11.034
  • 作者列表:"Bohl MA","Sethi R","Leveque JC
  • 发表时间:2020-02-01
Abstract

OBJECTIVE:To measure the incidence and severity of cement extravasation in adult patients undergoing prophylactic vertebroplasty as part of a spinal reconstruction procedure. METHODS:Consecutive adult patients treated with prophylactic vertebroplasty during a spinal reconstruction procedure were reviewed over a 46-month period. Patients without a postoperative computed tomography scan were excluded. Spine reconstruction was defined as any procedure involving ≥6 levels of fusion or a 3-column osteotomy. Cement extravasation was graded using a novel grading system. Fisher exact tests were performed to identify independent predictors of cement extravasation. RESULTS:Inclusion and exclusion criteria were met by 34 patients comprising 112 vertebral bodies (VB). All 34 patients (100%) had computed tomography evidence of cement extravasation. Of 112 VBs, 103 (92.0%) demonstrated cement extravasation. Thirteen VBs (11.6%) in 9 patients (26.5%) had cement extending to the vena cava or end-organs or cement causing spinal canal stenosis (grade 4 and 5 extravasation). No permanent clinical sequelae were found in these 9 patients. Upper thoracic vertebrae (C7-T6) had significantly higher rates of grade 4 and 5 extravasation than lower thoracic-lumbar vertebrae (T7-L5) (P = 0.004). CONCLUSIONS:Although no patients in this study experienced known long-term consequences of prophylactic vertebroplasty, 26.5% of patients had cement extravasation that threatened end-organs or neural elements. These results prompted us to change our practice from cementing upper thoracic VBs to using hooks instead. Cement injection is associated with serious risks and should be performed selectively. Larger prospective studies are needed to verify these results.

摘要

目的: 测量作为脊柱重建手术一部分的预防性椎体成形术的成年患者骨水泥外渗的发生率和严重程度。 方法: 回顾了 46 个月期间在脊柱重建手术中接受预防性椎体成形术治疗的连续成人患者。排除术后无计算机断层扫描的患者。脊柱重建定义为任何涉及 ≥ 6 级融合或 3 柱截骨的手术。使用新型分级系统对水泥外渗进行分级。进行Fisher精确检验以确定水泥外渗的独立预测因子。 结果: 符合纳入和排除标准的 34 例患者包括 112 个椎体 (VB)。所有 34 例患者 (100%) 有骨水泥外渗的计算机断层扫描证据。在 112 个VBs中,103 个 (92.0%) 显示水泥外渗。9 例 (11.6%) 患者中有 13 例VBs (26.5%) 骨水泥延伸至腔静脉或终末器官或骨水泥导致椎管狭窄 (4 级和 5 级外渗)。这 9 例患者均未发现永久性临床后遗症。上胸椎 (C7-T6) 4 级和 5 级外渗的发生率显著高于下胸椎 (T7-L5) (P = 0.004)。 结论: 尽管本研究中没有患者经历过预防性椎体成形术的已知长期后果,但 26.5% 的患者存在骨水泥外渗,危及终末器官或神经成分。这些结果促使我们改变我们的做法,从固井上胸VBs改为使用钩。骨水泥注入与严重风险相关,应选择性地进行。需要更大的前瞻性研究来验证这些结果。

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影响因子:1.41
发表时间:2020-03-01
DOI:10.1177/1078155219842277
作者列表:["Gyori DJ","Bullington SM","Crawford BS","Vernon VP"]

METHODS:BACKGROUND:National guidelines recommend screening and treatment for cancer-related bone disease and continued monitoring of bone-modifying agents. It is unclear whether a standardized screening tool is utilized to identify eligible patients and ensure appropriate supportive care is implemented. The purpose of this study was to evaluate current prescribing practices and optimize management of bone-modifying agents. METHODS:A retrospective chart review was performed to identify patients who received hormone deprivation therapy or had bone metastases through Hematology/Oncology or Urology clinics from 1 November 2016 to 31 October 2017. The primary endpoints of this study were the incidence of completed baseline dual-energy X-ray absorptiometry (DEXA) scan for patients on hormone deprivation therapy and percent of patients started on a bone-modifying agent for the prevention of skeletal-related events secondary to bone metastasis. Secondary endpoints included percent of patients with dental examinations prior to initiation, adequate calcium and vitamin D supplementation, incidence of osteonecrosis of the jaw or flu-like symptoms and education, and percent of bisphosphonate doses appropriately adjusted based on renal function. RESULTS:A total of 375 patients were assessed for baseline DEXA scans and bone-modifying therapy. Of the 226 patients on hormone deprivation therapy, 111 (49%) patients were appropriately screened with a DEXA scan prior to initiation of hormone deprivation therapy. Among the 149 patients with bone metastases, only 94 (63.1%) patients were started on a bone-modifying agent. CONCLUSIONS:Opportunities have been identified to optimize management of patients with cancer-related bone disease. Implementation of standardized tools may increase the rate of appropriate screening and initiation of bone-modifying therapy when warranted.

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骨肿瘤是发生于骨骼或其附属组织的肿瘤。有良性,恶性之分,良性骨肿瘤易根治,预后良好,恶性骨肿瘤发展迅速,预后不佳,死亡率高。

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