经皮椎体成形术在椎体良、恶性病变的临床研究

The research of the clinical applications of Percutaneous Vertebroplasty in Benign and Malignant Vertebral Disease

目的探讨经皮椎体成形术(PVP)在椎体良、恶性病变的临床应用价值。方法治疗200例276节椎体病变,其中骨质疏松症并椎体压缩性骨折174例232节、椎体血管瘤4例12节、转移瘤20例28节、多发性骨髓瘤2例4节。除第1例在CT和C臂X线机联合监视下完成外,其余均在C臂X线机监视下完成。一般单侧进针,对部分可疑病例先行活检术、再行PVP术,骨水泥(PMMA)用量在2～8ml。结果活检结果:4例结肠癌转移,2例肝癌转移,2例肺癌转移;60例为骨质疏松改变。PVP穿刺成功率100%,止痛效果达96%,椎体的高度有不同程度的恢复。162例仅作1次PVP即基本消除疼痛症状,8例部分缓解、作第二次PVP后疼痛症状基本消除。术后有1例出现恶心、呕吐36h,3例出现轻度肺栓塞,经对症处理后均消失。1例出现双下肢全瘫,经保守治疗,8月后完全康复。随访6～24月,骨质疏松症并压缩性骨折的病例无复发,而恶性肿瘤的病例复发5例(5/10、50%)。结论PVP治疗椎体良恶性病变的止痛效果确切,PVP术操作安全、快速、效果确切,值得推广。

Objective To evaluate percutaneous vertebroplasty(PVP)in the vertebral body for the treatment of benign and malignant tumor diseases.Methods PVP were performed in 200 patiens with 276 vertebral bodies.174 patients of 232 vertebraes were osteoporotic fractures,4patients of 12 vertebraes were hemangiomas,20 patients of 28 vertebraes were metastatic neoplasms,and 2 patient of 4 vertebraes was multiple myeloma.except the first case,PVP procedures were done by CT and C-arm fluoroscopy,the rest were done by C-arm fluoroscopy.ordinary puncture was done by one side,In some suspicious cases,biopsy were done first,and then PVP were done,2 to 8 ml of PMMA was injected per vertebra.Results biopsy result:4 patients were metastatic neoplasms from colon,2 patient was metastatic neoplasms from liver,2 patient was metastatic neoplasms from lung,60 patient were osteoporosis,The successive rate of PVP was 100%,The relieve pain rate was 96%,The altitude of vertebral body were recovered in some level.The pain were removed basically in 162 cases only one times by PVP,8 cases partly alleviated,and the pain were removed basically after the second times by PVP.Post PVP,1case felt nauseated,vomit for 36 hours,3 cases were lightly pulmonary embolism,they were recovered after treatment.1 case was paralyzed of lower limbs,she was recovered completely.The follow up period was 6～24 months.The cases of osteoporotic vertebral compress fractures were not recured,but 5 cases of malignant tumor were recured(5/10、50%).Conclusion PVP provides significant pain relief in both benign and malignant lesions.Procedure of PVP is safe,quick and exact.It is worth to spread.