Perkütan Transpediküler Vertebroplastide Kemik Çimento Kaçağı: Yirmi Hastanın Analizi

  • Soner Çivi Başkent Üniversitesi Tıp Fakültesi
  • Emre Durdağ Başkent Üniversitesi Tıp Fakültesi
  • Halil İbrahim Süner Başkent Üniversitesi Tıp Fakültesi
  • Özgür Kardeş Başkent Üniversitesi Tıp Fakültesi
  • Kadir Tufan Başkent Üniversitesi Tıp Fakültesi

Abstract

Amaç: Perkütan vertebroplasti (PVP) spinal cerrahide sık uygulanan girişim yöntemlerinden biridir. Bu girişime bağlı en yaygın komplikasyon kemik çimento migrasyonudur. Çimento migrasyonu çoğu zaman asemptomatik olsa da parapleji, pulmoner embolizm gibi ciddi komplikasyonlara yol açabilir. Yaptığımız bu çalışmada vertebroplasti girişimlerinde meydana gelen kemik çimento kaçağını saptamak ve PVP işleminin sonuçlarını değerlendirmek ve meydana gelen komplikasyonların sonuçlarını değerlendirerek gelecek dönemde yapılacak girişimlere ışık tutmasını amaçladık. Yöntem: Kliniğimizde 2009-2016 yılları arasında perkütan vertebroplasti uygulanan 20 (14 K ve 6 E) hasta ve girişimde bulunulan 26 vertebra çalışmaya dahil edildi. Onyedi vertebra osteoporotik kompresyon (%65.3), 4 vertebra patolojik kompresyon fraktürü (%15.3), 4 vertebra travmatik kompresyon fraktürü (%15.3), 1 vertebra ise hemanjiom (%3.8) nedeniyle işleme alındı. Kemik çimentonun migrasyon lokalizasyonları venöz pleksus, paravertebral yumuşak doku, spinal kanal, intervertebral foramen, kanül trasesinin içi ve disk mesafesi olarak sınıflandırıldı. Bulgular: Vertebraların 12’sinde korpus dışına kaçak izlenmezken (%46.1), 5 vertebrada kanül trasesine kaçak (%19.2), 3 vertebrada disk mesafesine kaçak (%11.5), 2’şer vertebrada venöz pleksus ve paravertebral dokulara kaçak (%7.6), 1’er vertebrada ise foraminal ve spinal kanal kaçak (%3.8) izlendi. Meydana gelen komplikasyonlara bağlı 1 hastada radiküler ağrı meydana geldi. Hastaların % 80 inde tam ağrı kontrolü sağlanırken ,%20 sinde kısmi ağrı kontrolü izlendi. Tartışma : Perkütan vertebroplasti girişiminde majör komplikasyonların meydana gelmesini engellemek için olası kaçak nedenlerinin belirlenmesi, uygulamanın doğru teknik ile yapılması, uygun miktar ve kıvamda kemik çimento kullanılması gerekmektedir. Çimento uygulaması öncesinde kaçak olasılığını belirlemek amacı ile kontrast kullanılarak x- ray kontrollerinin yapılması olası kötü sonuçları en aza indirgemek için dikkat edilemesi gereken hususların başında yeralmaktadır.

Author Biographies

Soner Çivi, Başkent Üniversitesi Tıp Fakültesi
Beyin ve Sinir Cerrahisi Ad.
Emre Durdağ, Başkent Üniversitesi Tıp Fakültesi
Beyin ve Sinir Cerrahisi Ad.
Halil İbrahim Süner, Başkent Üniversitesi Tıp Fakültesi
Beyin ve Sinir Cerrahisi Ad.
Özgür Kardeş, Başkent Üniversitesi Tıp Fakültesi
Beyin ve Sinir Cerrahisi Ad.
Kadir Tufan, Başkent Üniversitesi Tıp Fakültesi
Başkent Üniversitesi Tıp Fakültesi

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Published
2017-12-22
Section
Original Research