经皮椎体成形术治疗骨质疏松性椎体压缩骨折

Osteoporotic Vertebral Compression Fractures Treated by Percutaneous Vertebroplasty

【目的】探讨经皮椎体成形术 (PVP)治疗骨质疏松性椎体压缩骨折的适应证、禁忌证、椎体造影的意义、关键技术 ,近期疗效及并发症的预防。【方法】治疗此类患者 34例 ,39节椎体压缩骨折 ,患者在C臂X线机透视下经椎弓根行椎体穿刺 ,用非离子型造影剂行椎体造影 ,注入粉 /液 /造影剂比例为 3∶2∶1的聚甲基丙烯酸甲脂 (PMMA) ,术后进行临床疗效评价和观察有无并发症发生。【结果】PVP技术成功率 10 0 % ,PM MA平均注入量胸椎 3.2ml,腰椎 4 .3ml。随访 1～ 15个月 ,完全缓解 (CR) ,部分缓解 (PR) ,无效 (NR) ,分别为 79.4 %、17.7%、2 .9% ,总有效率 97.1% ;5例发生并发症 ,椎体周围PMMA渗漏 ,无一例出现临床症状。【结论】PVP治疗骨质疏松性椎体压缩骨折安全可行 ,椎体造影有助于预测PMMA在椎体内的分布状况和发生渗漏的可能性 ,避免发生严重并发症 ;主要并发症为PMMA渗漏 ,防止渗漏的关键是椎体造影后调配PM

Objectives]To explore the indications, contraindications, significance of vertebrography, crucial techniques, short-term therapeutic efficacy and prevention of complication during the application of percutaneous vertebroplasty (PVP) for treatment of osteoporotic vertebral compression fractures (OVCF).()Thirty-four patients displayed 39 OVCFs, their diagnoses were confirmed by plain radiograph(CT or MRI). Using local anesthesia, PVP was performed under CT together with C-arm fluoroscopy or C-arm fluoroscopy monitoring alone. Intraosseous venography was undertaken on each fractured vertebra by manual injection of nonionic contrast agent after successful puncture. Polymethylmethacrylate(PMMA) mixture with a ratio of powder/liquid/contrast agent as 3∶2∶1 was injected. After operation, CT scanning was carried out to trace PMMA distribution in the vertebra and to clarify if there was any leakage of PMMA. The clinical efficacy was evaluated and complication observed.The technical success rate of PVP was 100%. The average dose of PMMA injection was 3.2ml for thoracic vertebra and 4.3ml for lumbar vertebra. The patients were followed-up for 1～15 months with the rates of complete remission (CR), partial remission (PR) and no remission (NR) of 79.4%,17.7% and 2.9%, respectively. Their total effective rate was 97.1%. Complication with peri-vertebral PMMA leakage was found in 5 cases, no clinical symptom appeared in any case.([Conclusions])PVP is a safe and feasible technique for the treatment of OVCF. The main complication is the leakage of PMMA, the key point for prevention is to adjust the viscosity of PMMA and accomplish the injection under fluoroscopy monitoring when it is still in viscid state.