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Eur heart J：罕见！骨水泥引发心室壁穿孔一例

2018-06-02 张莉娟 心在线

骨水泥栓塞心室壁穿孔椎体形成术后
关注

椎体成形术后因骨水泥引起的栓塞非常罕见，因骨水泥栓塞引起心内栓塞更为罕见。

椎体成形术后因骨水泥引起的栓塞非常罕见，因骨水泥栓塞引起心内栓塞更为罕见。近日，《欧洲心脏杂志》（EHJ）就报道了一例因骨水泥引发心内栓塞，继而导致心包积液和心室壁穿孔的罕见案例，该病例作者是来自德国卡尔斯鲁厄（Karlsruhe）市立医院心内科和心外科医生团队，让我们一起来看看吧。

病例简介

患者，女，58岁，于注射聚甲基丙烯酸甲酯(PMMA)骨水泥的椎体后凸成形术（L2+L4）后第1天发生心绞痛和呼吸困难，怀疑急性冠脉综合征转至心内科治疗。

辅助检查

血液检查显示肌钙蛋白和D-二聚体水平升高。行冠脉造影无狭窄病变，但发现了无法识别的不透射光状物（图A）。

行胸部X线断层扫描发现因胸部骨水泥渗漏，致多处肺动脉栓塞（图B）。

超声心动图发现右心室处有细长致密心内容物，与水泥栓塞表现一致（图C）。

治疗经过

心脏内外科团队对病例进行充分广泛讨论后，决定给予保守治疗，予以抗凝。

4天后，行常规超声心动图和胸部X线断层扫描显示心包积液和右室壁穿孔（图D）。

转心外科急诊手术，行胸骨正中切开术，于右室壁穿孔部位取出一个5 cm×2 mm大小水泥栓子（图E、F）。患者住院一段时间后，转至康复中心。



讨论

椎体成形术后骨水泥栓塞是一种罕见但严重危及生命的并发症，心内栓塞更为罕见，目前尚无针对性的最佳治疗方式。本案例中对栓子行手术移除属于诊疗个例，不同患者的评估治疗要具体问题具体分析。

原始出处：

Patrick Swojanowsky， Maria Brinkmeier-Theofanopoulou， et al. A rare cause of pericardial effusion due to intracardiac cement embolism. Eur heart J.2018.

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    2018-06-04 zhaojie88

    #ART#

    0

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    2018-06-04 zhs3882

    #骨水泥#

    0

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    2018-06-04 lanyan20020086

    #穿孔#

    0

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    2018-06-04 syscxl

    #罕见#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1356809, encodeId=593d135680988, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Mon Jun 04 12:27:00 CST 2018, time=2018-06-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1370329, encodeId=780613e03299c, content=<a href='/topic/show?id=b103101e18e7' target=_blank style='color:#2F92EE;'>#骨水泥#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101718, encryptionId=b103101e18e7, topicName=骨水泥)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b952312, createdName=zhs3882, createdTime=Mon Jun 04 12:27:00 CST 2018, time=2018-06-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1377966, encodeId=0a3413e79669d, content=<a href='/topic/show?id=0d1ce5437ef' target=_blank style='color:#2F92EE;'>#穿孔#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=75437, encryptionId=0d1ce5437ef, topicName=穿孔)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0ee7414, createdName=lanyan20020086, createdTime=Mon Jun 04 12:27:00 CST 2018, time=2018-06-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1467323, encodeId=183d146e3232d, content=<a href='/topic/show?id=ef32e9539e8' target=_blank style='color:#2F92EE;'>#罕见#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79539, encryptionId=ef32e9539e8, topicName=罕见)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=29f36868190, createdName=syscxl, createdTime=Mon Jun 04 12:27:00 CST 2018, time=2018-06-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562910, encodeId=704d1562910be, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Mon Jun 04 12:27:00 CST 2018, time=2018-06-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=321233, encodeId=1933321233d9, content=不错的文章值得拥有, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=eff51996281, createdName=1e1b8538m79(暂无匿称), createdTime=Sun Jun 03 23:06:46 CST 2018, time=2018-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=321020, encodeId=fd343210209d, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c3da1990174, createdName=yfjms, createdTime=Sun Jun 03 06:57:46 CST 2018, time=2018-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=320935, encodeId=658932093595, content=学习了.谢谢分享., beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Sat Jun 02 22:03:42 CST 2018, time=2018-06-02, status=1, ipAttribution=)]
    2018-06-04 slcumt

    #HEART#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1356809, encodeId=593d135680988, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Mon Jun 04 12:27:00 CST 2018, time=2018-06-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1370329, encodeId=780613e03299c, content=<a href='/topic/show?id=b103101e18e7' target=_blank style='color:#2F92EE;'>#骨水泥#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101718, encryptionId=b103101e18e7, topicName=骨水泥)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b952312, createdName=zhs3882, createdTime=Mon Jun 04 12:27:00 CST 2018, time=2018-06-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1377966, encodeId=0a3413e79669d, content=<a href='/topic/show?id=0d1ce5437ef' target=_blank style='color:#2F92EE;'>#穿孔#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=75437, encryptionId=0d1ce5437ef, topicName=穿孔)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0ee7414, createdName=lanyan20020086, createdTime=Mon Jun 04 12:27:00 CST 2018, time=2018-06-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1467323, encodeId=183d146e3232d, content=<a href='/topic/show?id=ef32e9539e8' target=_blank style='color:#2F92EE;'>#罕见#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79539, encryptionId=ef32e9539e8, topicName=罕见)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=29f36868190, createdName=syscxl, createdTime=Mon Jun 04 12:27:00 CST 2018, time=2018-06-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562910, encodeId=704d1562910be, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Mon Jun 04 12:27:00 CST 2018, time=2018-06-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=321233, encodeId=1933321233d9, content=不错的文章值得拥有, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=eff51996281, createdName=1e1b8538m79(暂无匿称), createdTime=Sun Jun 03 23:06:46 CST 2018, time=2018-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=321020, encodeId=fd343210209d, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c3da1990174, createdName=yfjms, createdTime=Sun Jun 03 06:57:46 CST 2018, time=2018-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=320935, encodeId=658932093595, content=学习了.谢谢分享., beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Sat Jun 02 22:03:42 CST 2018, time=2018-06-02, status=1, ipAttribution=)]
    2018-06-03 1e1b8538m79(暂无匿称)

    不错的文章值得拥有

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1356809, encodeId=593d135680988, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Mon Jun 04 12:27:00 CST 2018, time=2018-06-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1370329, encodeId=780613e03299c, content=<a href='/topic/show?id=b103101e18e7' target=_blank style='color:#2F92EE;'>#骨水泥#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101718, encryptionId=b103101e18e7, topicName=骨水泥)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b952312, createdName=zhs3882, createdTime=Mon Jun 04 12:27:00 CST 2018, time=2018-06-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1377966, encodeId=0a3413e79669d, content=<a href='/topic/show?id=0d1ce5437ef' target=_blank style='color:#2F92EE;'>#穿孔#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=75437, encryptionId=0d1ce5437ef, topicName=穿孔)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0ee7414, createdName=lanyan20020086, createdTime=Mon Jun 04 12:27:00 CST 2018, time=2018-06-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1467323, encodeId=183d146e3232d, content=<a href='/topic/show?id=ef32e9539e8' target=_blank style='color:#2F92EE;'>#罕见#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79539, encryptionId=ef32e9539e8, topicName=罕见)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=29f36868190, createdName=syscxl, createdTime=Mon Jun 04 12:27:00 CST 2018, time=2018-06-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562910, encodeId=704d1562910be, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Mon Jun 04 12:27:00 CST 2018, time=2018-06-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=321233, encodeId=1933321233d9, content=不错的文章值得拥有, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=eff51996281, createdName=1e1b8538m79(暂无匿称), createdTime=Sun Jun 03 23:06:46 CST 2018, time=2018-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=321020, encodeId=fd343210209d, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c3da1990174, createdName=yfjms, createdTime=Sun Jun 03 06:57:46 CST 2018, time=2018-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=320935, encodeId=658932093595, content=学习了.谢谢分享., beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Sat Jun 02 22:03:42 CST 2018, time=2018-06-02, status=1, ipAttribution=)]
    2018-06-03 yfjms

    学习

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1356809, encodeId=593d135680988, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Mon Jun 04 12:27:00 CST 2018, time=2018-06-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1370329, encodeId=780613e03299c, content=<a href='/topic/show?id=b103101e18e7' target=_blank style='color:#2F92EE;'>#骨水泥#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101718, encryptionId=b103101e18e7, topicName=骨水泥)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b952312, createdName=zhs3882, createdTime=Mon Jun 04 12:27:00 CST 2018, time=2018-06-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1377966, encodeId=0a3413e79669d, content=<a href='/topic/show?id=0d1ce5437ef' target=_blank style='color:#2F92EE;'>#穿孔#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=75437, encryptionId=0d1ce5437ef, topicName=穿孔)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0ee7414, createdName=lanyan20020086, createdTime=Mon Jun 04 12:27:00 CST 2018, time=2018-06-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1467323, encodeId=183d146e3232d, content=<a href='/topic/show?id=ef32e9539e8' target=_blank style='color:#2F92EE;'>#罕见#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79539, encryptionId=ef32e9539e8, topicName=罕见)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=29f36868190, createdName=syscxl, createdTime=Mon Jun 04 12:27:00 CST 2018, time=2018-06-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562910, encodeId=704d1562910be, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Mon Jun 04 12:27:00 CST 2018, time=2018-06-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=321233, encodeId=1933321233d9, content=不错的文章值得拥有, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=eff51996281, createdName=1e1b8538m79(暂无匿称), createdTime=Sun Jun 03 23:06:46 CST 2018, time=2018-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=321020, encodeId=fd343210209d, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c3da1990174, createdName=yfjms, createdTime=Sun Jun 03 06:57:46 CST 2018, time=2018-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=320935, encodeId=658932093595, content=学习了.谢谢分享., beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Sat Jun 02 22:03:42 CST 2018, time=2018-06-02, status=1, ipAttribution=)]
    2018-06-02 惠映实验室

    学习了.谢谢分享.

    0