经皮椎体成形术中骨水泥渗漏与术后椎体再塌陷的防控策略研究进展

doi:10.3969/j.issn.1009-976X.2026.03.010

摘要/Abstract

摘要： 经皮椎体成形术（PVP）治疗骨质疏松性椎体压缩性骨折（OVCF）虽能实现即时止痛与力学支撑,但骨水泥渗漏、责任椎体再塌陷及邻椎骨折等并发症仍是制约其远期疗效的临床难题。本文聚焦PVP术后并发症的防控,从手术操作环节的细节优化入手进行综述。研究表明：在穿刺入路方面,应用弯角套管技术（PCVP）或双侧穿刺可优化椎体内应力分布,降低继发性骨折风险;引入实时超声融合、计算机导航等数字化技术能降低非引导下穿刺带来的周围组织损伤与骨水泥渗漏风险;在骨水泥应用环节,将注入量控制在4~6 mL、采用高黏度骨水泥,并确保其在椎体内充分接触上下终板,是维持力学稳定、预防再塌陷的重要环节。此外,新型生物活性骨水泥在减少热损伤方面展现出良好前景。临床医师应通过精细化的技术组合与参数调控,降低PVP手术风险,改善患者远期预后。

关键词: 骨质疏松性椎体压缩性骨折, 经皮椎体成形术, 骨水泥渗漏, 骨水泥优化

Abstract: Percutaneous vertebroplasty （PVP） for osteoporotic vertebral compression fractures （OVCFs） provides immediate pain relief and mechanical support. However, complications such as bone cement leakage, re-collapse of the treated vertebra, and adjacent vertebral fractures remain clinical challenges that limit long-term efficacy. This review focuses on the prevention and management of post-PVP complications, systematically summarizing optimization strategies with an emphasis on procedural details. Regarding puncture approaches, research indicates that, the application of percutaneous curved vertebroplasty （PCVP） or a bilateral puncture approach can optimize intravertebral stress distribution and reduce the risk of secondary fractures. The introduction of digital technologies, such as real-time ultrasound image fusion and computer navigation, significantly mitigates the risks of injury to surrounding tissues and bone cement leakage associated with unguided puncture. In terms of bone cement application, controlling the volume at 4~6 ml, utilizing high-viscosity cement, and ensuring sufficient contact with the superior and inferior endplates are essential for maintaining mechanical stability and preventing re-collapse. Furthermore, novel bioactive bone cements show potential for reducing thermal injury and promoting bone healing. Clinicians should minimize procedural risks associated with PVP and improve long-term outcomes through optimized combinations of techniques and precise control of procedural parameters.

Key words: osteoporotic vertebral compression fracture, percutaneous vertebroplasty, bone cement leakage, bone cement optimization, complication prevention

中图分类号:

R683.2

韩文广, 符碧峰, 薛景景, 张晓宇, 吴思, 刘爱峰, 朱文辉, 张小青. 经皮椎体成形术中骨水泥渗漏与术后椎体再塌陷的防控策略研究进展[J]. 岭南现代临床外科, 2026, 26(03): 201-207.

HAN Wenguang, FU Bifeng, XUE Jingjing, ZHANG Xiaoyu, WU Si, LIU Aifeng, ZHU Wenhui, ZHANG Xiaoqing. Avoiding cement leakage and vertebral recollapse after percutaneous vertebroplasty： advances in optimization strategies[J]. Lingnan Modern Clinics In Surgery, 2026, 26(03): 201-207.

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