经皮椎体成形术治疗症状性胸、腰椎体血管瘤

Percutaneous vertebroplasty for symptomatic hemangiomas in thoracic or lumbar vertebrae

目的探讨经皮椎体成形术（percutaneous vertebroplasty，PVP）治疗症状性椎体血管瘤的临床疗效。方法2002年12月。2005年4月共治疗10例，其中胸椎6例，腰椎4例，均在数字减影血管造影引导下进行，单侧或双侧椎弓根入路进针。PMMA按粉、液及造影剂比例为3：2：1进行调配，“牙膏期”用螺旋式加压装置推入，骨水泥注射量胸椎为4—6ml，平均4．8ml，耀椎为5～8ml。平均6．0ml。结果10例PVP顺利完成，手术时间25—60min，平均39．5min。术中出血量10-50ml，平均19．6ml。无骨水泥渗漏、肺动脉栓塞等并发症发生。10例术后随访2—30个月，平均18个月，9例症状体征消失。未出现新的椎体压缩性骨折，血管瘤无复发；1例L3血管瘤术后1年仍感腰部轻度阵发性隐痛，但可正常生活工作，无神经功能障碍出现。结论经皮椎体成形术是治疗症状性椎体血管瘤的安全有效的微创手术。

Objective To study clinical results of percutaneous vertebroplasty （PVP） for the treatment of symptomatic vertebral hemangiomas. Methods A total of 10 patients with vertebral hemangioma （thoracic vertebrae, 6 patients; lumbar vertebrae, 4 patients） were treated from December 2002 to April 2005. Under the guidance of digital subtraction angiography （DSA）, a needle was advanced into the vertebral body via a unipedicular or bipedicular approach. The preparation of polymethylmethacrylate （PMMA） was mixed with 3 doses of powder, 2 doses of liquid, and 1 dose of contrast until a doughy, cohesive consistency similar to toothpaste was obtained. Then the PMMA cement was injected into the vertebral body by using a high-pressure plunger. The total injection volume ranged 4 -6 ml （mean, 4.8 ml） in the thoracic vertebrae and 5 -8 ml （mean, 6.0 ml） in the lumbar vertebrae. Results The procedure was completed smoothly in all 10 patients. The operation time was 25 -60 min （mean, 39.5 min） and the intraoperative blood loss was 10 - 50 ml （mean, 19.6 ml）. No incidence of cement leakage or pulmonary embolism occurred. The 10 patients were followed for 2 - 30 months （mean, 18 months）. In 9 patients, free of signs and symptoms was achieved and no vertebral compression fracture or recurrence of hemangioma was observed. One patient with L3 hemangioma still complained of mild and paroxysmal loin pain at 1 year after procedure, but the patientg normal activities were unaffected and no nervous dysfunction was found. Conclusions Percutaneous vertebroplasty is a safe and effective treatment for symptomatic vertebral hemangiomas.