背景:经皮椎体后凸成形术(PKP)是一种用于治疗椎体压缩性骨折的微创技术。尽管PKP简单且相对安全,严重的并发症是可能的。这里,我们报告一个新的,与此过程相关的严重并发症,即非闭塞性肠系膜缺血(NOMI)。
方法:一名83岁女性患者,以前身体健康,向后倒下,落在她的臀部,随后经历了持续的腰痛,在转身或坐起来时加剧。
方法:腰椎造影显示L1椎体楔形畸形。腰椎磁共振成像显示L1椎体新鲜压缩性骨折。
方法:创伤后的第2天,患者在局部麻醉下接受PKP.麻醉效果令人满意,程序进展顺利。
结果:患者在术后1小时至3天内出现右腹部轻度不适,第4天轻度腹胀,第5天突然剧烈腹痛.即时腹部计算机断层扫描显示升结肠和肝曲缺血性改变,伴有肝门静脉气体。一个小时后,腹痛自发消退。大约5个小时后,增强的腹部计算机断层扫描显示肠系膜脉管系统没有充盈缺陷,没有管腔狭窄或闭塞,增强的肠壁,肝门静脉气体明显改善。考虑到NOMI和与肠系膜上动脉痉挛相关的缺血,开始血管扩张剂治疗(盐酸罂粟碱),导致有利的结果。在第17天,肝曲的病理检查显示中度,急性,和慢性粘膜炎症,随着间质纤维组织增生,提供明确的证据支持缺血性改变。她在成功康复后的第18天出院。
结论:PKP后NOMI的发生并不常见。然而,一旦发生,延误诊断或误诊会导致肠坏死和腹腔感染等严重后果,甚至危及病人的生命。我们目前缺乏预防这种并发症的经验,但及时诊断和适当干预是治疗此类并发症的有效措施。
BACKGROUND: Percutaneous kyphoplasty (PKP) is a minimally invasive technique employed for treating vertebral compression fractures. Although PKP is simple and relatively safe, severe complications are possible. Here, we report a new, severe complication linked to this procedure, namely nonocclusive mesenteric ischemia (NOMI).
METHODS: An 83-year-old female patient, previously in good health, fell backward, landing on her buttocks, and subsequently experienced persistent low-back pain that exacerbated during turning or sitting up.
METHODS: Lumbar spine radiography revealed wedge deformity of the L1 vertebral body. Lumbar spine magnetic resonance imaging indicated a fresh compression fracture of the L1 vertebral body.
METHODS: On the 2nd day following the trauma, the patient underwent PKP under local anesthesia. Anesthesia was satisfactory, and the procedure progressed smoothly.
RESULTS: The patient experienced mild discomfort in the right abdomen within the 1st hour to 3 days postoperatively, mild abdominal distension on the 4th day, and sudden severe abdominal pain on the 5th day. Immediate abdominal computed tomography revealed ischemic changes in the ascending colon and hepatic flexure, accompanied by hepatic portal venous gas. An hour later, abdominal pain spontaneously subsided. Approximately 5 hours later, an enhanced abdominal computed tomography revealed no filling defects in the mesenteric vasculature, absence of luminal narrowing or occlusion, enhanced intestinal walls, and a notable improvement in hepatic portal venous gas. Considering NOMI and ischemia related to superior mesenteric artery spasm, vasodilator therapy (papaverine hydrochloride) was initiated, leading to favorable outcomes. On day 17, pathological examination of the hepatic flexure revealed moderate, acute, and chronic mucosal inflammation, along with interstitial fibrous tissue proliferation, providing clear evidence supporting ischemic changes. She was discharged on day 18 after a successful recovery.
CONCLUSIONS: The occurrence of NOMI after PKP is uncommon. Yet, once it happens, delayed diagnosis or misdiagnosis can lead to serious consequences such as intestinal necrosis and abdominal infection, even endangering the patient\'s life. We currently lack experience in preventing this complication, but timely diagnosis and appropriate intervention are effective measures in treating such complications.