经皮椎体成形术治疗椎体良恶性病变的临床技术应用探讨

Percutaneous vertebroplasty in benign and malignant vertebral diseases

目的 探讨经皮椎体成形术 (PVP)在治疗椎体良恶性病变中的技术操作问题。方法对 2 9例的 41个椎体病变共行 46侧PVP治疗 ,包括椎体转移瘤 16例 ,骨质疏松压缩性骨折 7例 ,椎体血管瘤 3例 ,骨髓瘤 1例 ,外伤性压缩性骨折 1例及不明原因骨破坏 1例。PVP在C形臂X线机或C形臂X线机 +CT组合机监视下进行 ,骨水泥 (PMMA)的粉、液比例为 3∶2 ,按椎体计算骨水泥用量为2～ 8ml。结果 46侧PVP成功 45侧 (97 8% )。本组疼痛完全缓解 (CR)者 19例 (19/ 2 9) ,部分缓解(PR)者 9例 (9/ 2 9) ,无效 (NR)者 1例 (1/ 2 9)。随访 2～ 11个月无复发。PVP术后无一例椎体塌陷加重或发生新的压缩 ,无一例发生严重并发症。结论 PVP技术安全可行 ,对腰椎等多数椎体行PVP只要在C形臂X线机监视下即可 ,熟练地掌握PMMA使用方法是PVP技术成功的关键因素。

Objective To evaluate percutaneous vertebroplasty (PVP) treatment for benign and malignant vertebral lesions from a technique view Methods PVP was performed in 29 consecutive patients with 41 vertebrae involvement, including 23 vertebral metastatic neoplasms in 16 patients, osteoporotic fractures within 10 vertebrae in 7 patient, shemangiomas in 3 patients , and other lesions in 3 patients PVP procedures were performed under the guidance of CT plus C arm fluoroscopy or fluoroscopy only Two to 8 ml of PMMA was injected per vertebra Results A technique success of PVP was obtained in 97 56% (40/41) CR and PR were reached in 65 52% and 31 03% respectively in a follow up of 2 10 months No further or new vertebral compression occurred in all patients at the last follow up No major complications occurred in this series, except asymptomatic PMMA leak around vertebrae demonstrated by CT in 3 cases Conclusions PVP provides significant pain relief in both benign and malignant lesions Procedure of PVP is safe and uncomplicated when performed under monitoring by C arm X ray machine in most cases It is stressed that a proper use of PMMA is a key factor for PVP procedure