經皮椎體成型術合併脊髓損傷及廣泛無症狀肺栓塞：病例報告

Spinal Cord Injury and Diffuse Asymptomatic Pulmonary Embolism after Percutaneous Vertebroplasty: A Case Report

10.6315/2010.38(4)07

陳耀仁(Yao-Jen Chen)；施貝嬖(Pei-Pi Shih)；蔡素如(Su-Ju Tsai)

經皮椎體成型術 ； 脊髓損傷 ； 肺栓塞 ； percutaneous vertebroplasty ； spinal cord injury ； pulmonary embolism

台灣復健醫學雜誌

38卷4期（2010 / 12 / 01）

255 - 261

繁體中文

經皮椎體成型術(percutaneous vertebroplasty)是利用X光導引注射骨泥(cement)到產生病變脊椎的一種侵襲性極小而有效的醫療技術，目前廣泛使用於骨質疏鬆造成的胸腰椎壓迫性骨折，以前的研究顯示效果良好而併發症少。但隨著接受經皮椎體成型術的數目快速增加，併發症的報告也隨之增加。本文描述一位三十歲女性病人，有第九、十、十一陳舊性胸椎壓迫性骨折，接受經皮椎體成型術後立即產生雙下肢癱瘓及大小便功能障礙，雖然接受兩次減壓手術，仍無任何復原的跡象，病人雖無喘或胸痛等症狀，但術後的胸部X光及電腦斷層卻顯示有廣泛性的肺栓塞。本文報告病例爲完全損傷而且合併廣泛無症狀肺栓塞，以前的病例報告未有同時出現脊髓損傷及肺栓塞的病例。經皮椎體成型術的嚴重併發症包括感染、脊髓損傷、心肺併發症及腦梗塞，其中心肺併發症出現症狀的時間可能是幾個月甚至幾年後，因此有被低估的可能。目前對於經皮椎體成型術的止痛機轉仍不清楚，使用前瞻性而且具有對照組的新研究顯示，注射骨泥與單純注射麻醉劑到脊椎的效果相同，若與保守療法相比較，經皮椎體成型術雖然止痛效果較快，但術後三個月則與保守療法呈現相同的效果。由於經皮椎體成型術可能併發嚴重併發症，而且臨床表現輕微時，併發症可能被低估，因此脊椎壓迫性骨折病人，是否須接受經皮椎體成型術的治療，必須謹慎評估。

A 30-year-old woman with a history of 9th to 11th thoracic vertebral compression fracture developed complete thoracic spinal cord injury immediately after percutaneous vertebroplasty. The patient did not have any sign of neurological recovery after two operations for spinal decompression. The postoperative chest X ray and thoracic computed tomography scan revealed diffuse asymptomatic pulmonary embolism, but the patient did not have dyspnea or chest pain. Percutaneous vertebroplasty has been generally considered a minimally invasive and effective procedure for treatment of painful compression fracture. Complications after percutaneous vertebroplasty include infection, spinal cord injury, cardiopulmonary complications and stroke. In previous literature search, there was no case report describing spinal cord injury combined with pulmonary embolism after percutaneous vertebroplasty. The risk of cardiopulmonary complications may be underestimated because the symptoms may appear several months to years later. Comparing the effect in reducing pain or promoting daily life, vertebroplasty is reported to have same effect with injecting short-duration anesthetic. While vertebroplasty offers better immediate pain reduction, when compared to conservative treatment 3 months after fracture, it has similar effect. Physiatrist should be prudent recommending vertebroplasty for painful spine compression fracture because of the possibility of severe complications.

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