侧卧位行经皮椎体成形术治疗骨质疏松椎体压缩性骨折的临床研究

Clinical evaluation of the treatment of osteoporotic compressive vertebral fractures by percutaneous vertebroplasty in lateral decubitus

目的探讨侧卧位行经皮椎体成形术（PVP）治疗骨质疏松椎体压缩性骨折的临床应用。方法透视下侧卧位行经皮椎体成形术治疗骨质疏松椎体压缩性骨折70例131个椎体。结果所有病例的手术都获得成功，所有病例术中和术后未出现严重的并发症。在经PVP术后的131个椎体中，112个椎体无椎体外渗漏，都经X线正侧位和（或）CT确诊。16例19个椎体出现椎体外渗漏，经X线正侧位和CT检查确诊，5例7个椎体出现椎间盘渗漏，7例8个椎体出现椎旁软组织渗漏，3例3个椎体出现椎外静脉丛渗漏，1例1个椎体出现椎弓根渗漏。随访3～6个月，病变椎体无复发。结论侧卧位行经皮椎体成形术治疗老年人椎体压缩性骨折止痛效果明确，能有效避免俯卧位带来的不良影响，提高PVP术的安全性。

Objective To discuss the clinical application of treatment of osteoporotic compressive vertebral fractures by percutaneous vertebroplasty （PVP） in lateral decubitus. Methods One hundred and thirty-one vertebras of 70 cases with osteoporotic compressive vertebral fractures were performed PVP guided by fluoroscopy in lateral decubitus. Results The operations were successful in all cases without severe complications during and after procedure. Radiography and/or spiral CT scan were performed in all patients after operation. Distribution of cement in 112 vertebrae was satisfactory. With radiography and spiral CT scan, the other 19 vertebrae of 16 cases showed leakages of cement outside the vertebral body including cement leakage into the adjacent intervertebral discs in 7 vertebrae of 5 cases, into the paravertebral soft tissue in 8 vertebrae of 7 cases, into the paravertebral venous plexus in 3 vertebrae of 3 case and into a pedicle of vertebral arch in 1 case. The mean follow-up duration was 3-6 months. The collapsed vertebral bodies have not recurred. Conclusion All cases with osteoporotic compressive vertebral fractures were performed PVP guided by fluoroscopy in lateral decubitus in which it relieves serious pain remarkably. PVP in lateral decubitus can effectively avoid complication comparing with PVP in ventral decubitus and raise safety of PVP.