摘要
患者,男,84岁,因"腰痛伴活动受限半年余"入院。入院查体:脊柱轻度后凸畸形,腰背部有明显压痛和叩击痛,双下肢肌力5级,皮肤感觉正常。腰椎MRI及CT示L 4椎体压缩性骨折。双能X线骨密度检测示:骨密度T值-2.6,提示骨质疏松。入院诊断:L 4椎体骨质疏松性压缩骨折。患者入院后完善相关检查,排除手术禁忌,于入院第4天行L 4经皮椎体后凸成形术。术毕出现呼之不应,血压下降至94/63 mmHg,氧饱和度下降至80%。颅脑CT示颅内多发斑点状气体密度影,腰椎CT示腰椎棘突旁软组织内积气,局部椎管内积气,双侧腹股沟区血管内点状气体密度影。诊断为颅内动脉气体栓塞。患者病情进一步恶化,意识丧失,伴颈项强直,双下肢肌张力增高,双侧Babinski征阳性,予脑保护、维持脑灌注、改善脑侧支循环等对症治疗,未苏醒。术后1个月出现肺部感染,术后3个月因呼吸衰竭死亡。病例提示椎体成形术中气体栓塞的潜在风险,应采取相应措施减少此类并发症的发生,包括减少静脉血与空气接触的时间、在套管内预先注入生理盐水以降低静脉血与空气的接触面积,适当增加静脉压力降低气体吸入的风险。建议选择直径较小的操作导管。对术前合并心脏疾病或高龄患者建议行心脏彩色多普勒检查,排除卵圆孔未闭合等解剖异常。
The patient,an 84-year-old man,was admitted to the hospital with"low back pain with limitation of movement for more than half a year".Admission examination:mild kyphotic deformity of the spine,significant tenderness and percussion pain in the lower back,bilateral lower limb muscle strength graded 5,normal skin sensation.Lumbar MRI and CT revealed a compressive fracture of the L 4 vertebra.Dual-energy X-ray absorptiometry(DEXA)indicated a bone mineral density T-score of-2.6,suggesting osteoporosis.Admission diagnosis:osteoporotic compressive fracture of the L 4 vertebra.The patient underwent thorough examinations to exclude surgical contraindications.On the fourth day of admission,the patient underwent percutaneous vertebroplasty of the L 4 vertebra.At the end of the operation,the patient became unresponsive,with a blood pressure drop to 94/63 mmHg and oxygen saturation falling to 80%.Cranial CT showed multiple punctate gas density shadows within the brain.Lumbar CT revealed gas accumulation in the soft tissue adjacent to the lumbar spinous processes,localized intraductal gas,and punctate gas density shadows within the vessels in both groin areas.The diagnosis was intracranial arterial gas embolism.The patient's condition deteriorated further,with loss of consciousness,neck stiffness,increased muscle tone of both lower limbs,and positive Babinski's sign on both sides.Symptomatic treatments included brain protection,maintaining cerebral perfusion,and improving collateral cerebral circulation,but the patient did not regain consciousness.The patient developed a pulmonary infection one month postoperatively and died three months postoperatively due to respiratory failure.This case highlights the potential risk of gas embolism during vertebroplasty.Measures to reduce such complications should be implemented,such as minimizing the duration of venous blood-air contact,pre-filling the cannula with saline to reduce the venous blood-air interface,and appropriately increasing venous pressure to reduce the risk of gas entry.It is recommended to use smaller diameter catheters.For patients with pre-existing cardiac conditions or elderly patients,preoperative cardiac Doppler ultrasound should be performed to exclude anatomical abnormalities such as patent foramen ovale.
作者
陈兵乾
季立标
钱宇锋
瞿晓宏
房小文
Chen Bingqian;Ji Libiao;Qian Yufeng;Qu Xiaohong;Fang Xiaowen(Department of Orthopaedics,Changshu Hospital Affiliated to Soochow University(Changshu First People's Hospital),Changshu 215500,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2024年第16期1114-1117,共4页
Chinese Journal of Orthopaedics
关键词
脊柱
骨质疏松性骨折
气体
颅内栓塞
病例报告
Spine
Osteoporotic fractures
Gases
Intracranial embolism
Case reports
