CT导引下椎体成形术在胸腰段椎体压缩性病变治疗中的临床应用

The Clinical Application of CT-guided PVP in the Treatment of Vertebral Compression Damage in between Thoracic and Lumbar Vertebrae

目的：探讨椎体成形术在治疗胸11-腰3椎体压缩性病变的应用及临床治疗效果。方法：经DR、CT、MRI检查，结合临床表现、病史明确诊断18例椎体压缩性病变，共涉及20个椎体，应用椎体成形术治疗。在CT导引下注入骨水泥，术中行CT扫描观察骨水泥注入量及椎体膨胀情况，临床观察患者疗效及并发症情况。结果：CT导引下经皮穿刺椎体成形术操作成功，经临床1～18个月不定期随访，16例患者在术后1个月内疼痛症状完全缓解；1例患者在术后时有神经根刺激症状，用药后症状可以改善，3个月复查症状完全缓解；1例患者手术前后症状未见明显变化；所有患者未出现严重并发症。术后1个月、3个月对病变行CT椎体扫描，18个椎体明显饱满扩大，骨水泥涵于椎体内；2个椎体外形轻度变化，骨水泥外溢于椎旁间隙。结论：CT定位导引下经皮穿刺椎体成形术，路径设计合理，穿刺成功率高，避免多次重复穿刺，所以创伤小、并发症少；有效地解除了由于椎体压缩性病变而引起的多种临床症状。

Object：To evaluate the clinical application as well as its therapeutic effects of percutaneous vertebroplasty （PVP） in the treatment of vertebral compression damage between thoracic vertebrae T11 to lumbar vertebrae L3. Methods： Through following examination such as CT scanning, DR and MRI, along with evaluation of clinical symptoms and medical history, 18 cases of vertebral compression damage have been diagnosed with certainty and PVP operation was adopted for the treatment of the 20 vertebrae affected. Bone cement was injected under CT guidance. The injection amount and the corresponding expansion in the vertebral body injected were also carefully monitored with CT scanning during PVP operation. The therapeutic effects as well as any possible complication were evaluated afterwards. Results： 18 CT- guided PVP operations were all successfully performed. After follow - up visit to all the patients during a time period ranging from 1 to 18 months, it has been found that as many as 16 patients exhibit complete relief of pain symptoms within as short as 1 month after operation; 1 patient exhibits irritating symptoms related to nerve root, which was alleviated upon medicine administration and completely relieved 3 months later. Only patient exhibits no significant improvement in pain symptoms after PVP. No clinically significant complication was found in all patients. CT follow - up evaluation of previously damaged vertebral bodies was carried out twice at the time point 1 month and 3 month after PVP, respectively. The results show that 18 vertebral bodies were obviously enlarged and plump in appearance due to accumulation of bone cement injected within and 2 other vertebral bodies were slightly deformed with bone cement leaking into paravertebral space. Conclusion ： CT - guided PVP operation is a safe technique reasonably designed with much less operation - related trauma as well as post - operation complication and much higher rate of puncture success for the effective relief of clinical symptoms caused by vertebral compression damage.