经皮椎体成形术后延迟硬膜内沙漏形骨水泥渗漏：病例报告

摘要(中文译文)

经皮椎体成形术（PVP）广泛用于稳定椎体压缩性骨折并缓解疼痛。虽然即刻骨水泥渗漏是已知的并发症，但迟发性渗漏极为罕见，全球报道极少。我们报告一例独特的迟发性骨水泥渗漏病例，发生于一名60岁中国女性PVP术后8个月，该患者有骨质疏松性椎体压缩性骨折及多次腰椎融合手术史。患者最初在PVP术后恢复顺利，但后来出现新发的下腰痛及双下肢神经根病。影像学显示骨水泥移位并渗漏至硬膜内间隙，呈沙漏型。遂行手术干预以移除渗漏的骨水泥并解除神经压迫，术后症状显著改善。患者继续接受为期一年的随访，未见症状复发或新发神经功能缺损。本病例强调了对高危PVP患者进行长期警惕的重要性。动态观察为迟发性渗漏的病理生理机制提供了新的见解。临床医生应考虑对严重骨质疏松、长期糖皮质激素暴露或既往融合手术的患者进行延长影像学监测。

Abstract

Percutaneous vertebroplasty (PVP) is widely used to stabilize vertebral compression fractures and alleviate pain. While immediate cement leakage is a known complication, delayed leakage is exceptionally rare, with very few reports worldwide. We report a unique case of delayed bone cement leakage occurring 8 months post-PVP in a 60-year-old Chinese female with a history of osteoporotic vertebral compression fractures and multiple lumbar fusion surgeries. Initially presenting with successful postoperative recovery following PVP, the patient later developed new-onset lower back pain and radiculopathy of the bilateral lower limbs. Imaging revealed migration and leakage of cement into the intradural space with an hourglass pattern. Surgical intervention was undertaken to remove the leaked cement and alleviate neural compression, resulting in significant symptomatic improvement. The patient was monitored for an additional year without any recurrence of symptoms or new neurologic deficits. This case underscores the importance of long-term vigilance in high-risk PVP patients. Dynamic observation provides new insight into the pathophysiology of delayed leakage. Clinicians should consider prolonged radiologic monitoring in patients with severe osteoporosis, chronic glucocorticoid exposure, or prior fusion surgery.

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