注射性锶羟磷灰石在椎体成形术中的临床应用

Percutaneous vertebroplasty with active Strontium-contained hydroxyapatite

目的探讨使用锶羟磷灰石行经皮椎体成形术的临床疗效。方法行经皮椎体成形术患者23例(36个椎体),男6例,女17例;年龄43～80岁,平均69.3岁;1个椎体13例,2个椎体7例,3个椎体3例。其中骨质疏松性椎体压缩骨折18例,脊椎血管瘤3例,多发性骨髓瘤2例。所有患者均采用经皮注入锶羟磷灰石治疗,对术中患者的血压、心率、血氧饱和度及术后感染、骨水泥渗漏、疼痛、活动度、影像学征象等指标与术前进行对比分析,了解治疗效果。结果术后CT扫描示8例11个椎体有少量渗漏,1例2个椎体有椎体后壁渗漏;2例2个椎体在椎间孔内有少量渗漏;5例7个椎体有椎旁渗漏,4例是因穿刺针使椎体前缘破溃所致。所有渗漏并未引起明显的神经损伤症状。23例行经皮椎体成形术患者,1例死亡,其余22例均获得随访,随访时间6～18个月,平均12.5个月。17例骨质疏松性椎体压缩骨折患者,11例疼痛基本消失,6例明显减轻;3例脊椎血管瘤患者疼痛基本消失;2例多发性骨髓瘤患者,1例疼痛明显减轻,1例缓解后又加重。末次随访时X线片与术后X线片比较示椎体并无继续塌陷的征象。结论锶羟磷灰石应用于经皮椎体成形术有较好的临床疗效和安全性。

Objective To study the curative efficacy of percutaneous vertebroplasty with Strontium-contained hydroxyapatite for osteoporotic vertebral compressive fracture and spinal tumor. Methods 23 patients (36 vertebrae) were recruited to the study, which were 6 males and 17 females, and the average age of patients was 69.3 years with a range of 43 to 80 years. Percutaneous vertebroplasties were performed on 1 vertebra in 13 cases, 2 vertebrae in 7, and 3 vertebrae in 3. 18 patients were diagnosed as osteoporotic vertebral compression fractures, 3 as spinal hemogioma and 2 as multiple myeloma. All patients were treated with injection of Strontium-contained hydroxyapatite percutaneously under the guidance of C arm intensifier. And some postoperative parameters were compared with that of preoperation in aiming to study the outcome, such as the blood pressure, heart rate, serum PO2 during operation, post-operative infection, cement leakage, pain, ROM and radiographic demonstrations. Results Among the 23 operative patients, all were available at final follow-up except 1 death; the mean duration of follow-up was 12.5 months (range, 6-18 months). Among the 18 osteoporotic vertebral compressive fractures, the pain disappeared mostly in 12 cases, and relieved obviously in 6 cases; pain also disappeared in all the 3 spinal hemogioma cases; and as for 2 multiple myeloma cases, one alleviated greatly, the other one aggravated after a short-term relief. The X-ray didn't reveal any collapse of the vertebral bodies compared with that at the right time after operation. The significant variations of heart rates, blood pressure and serum PO2 were not observed during and after operation. A small amount of leakage was found on postoperative CT imagines in 8 cases(11 vertebrae) without nervous symptoms. Conclusion In using percutaneous vertebroplasty with the Strontium-contained hydroxyapatite for osteoporotic vertebral compression fractures, spinal hemogioma and multiple myeloma, the clinical outcomes are safe and efficient.