渐进性经皮椎体成形术预防骨水泥外渗的研究

Prevention of cement leaking in gradually percutaneous vertebroplasty

目的探讨渐进性经皮椎体成形术预防骨水泥外渗的原理与效果。方法15例椎体肿瘤,其中转移性肿瘤13例、椎体血管瘤2例,44例骨质疏松性压缩性骨折,8例外伤性压缩性骨折,共67例80个椎体采用渐进性经皮椎体成形术。经皮椎弓根穿刺注入造影剂,无造影剂外渗进入椎管的共52例61个椎体,显示造影剂外渗进入椎管的共15例19个椎体。将骨水泥(PMMA)搅拌至凝胶状后,在C形臂X线机透视下缓慢逐渐注入,对有骨水泥渗入椎体后缘者暂停推注,并调整注射针的深度至椎体前份再逐渐注入造影剂。结果19个造影剂外渗进入椎管的椎体通过渐进性注入骨水泥,未发现渗入椎管内。结论用渐进性经皮椎体成形术预防骨水泥外渗进入椎管具有可行性。

Objective To explore the principle and effect in prevention of cement leaking in gradually percutaneous vertebroplasty. Methods Sixty-seven cases including 80 vertebral bodies were treated with percutaneous vertebroplasty. There were 15 cases of vertebral tumors （ including 13 metastatic tumors and 2 vertebral hemangiomas）, 44 cases of osteoporotic vertebral compression fractures （VCF） and 8 cases of traumatic VCF. There were i5 cases including 19 vertebral bodies with extravasa＇ tion of contrast media into vertebral canal, and 52 cases including 61 vertebral bodies without extravasation into Vertebral canal after the contrast media was injected through percutaneous transpedicular puncture. The bone cement （PMMA） was injected gradually with C-arm fluoroscopy when it was stirred into the state of gel. In case of extravasation of bone cement into the pos. terior edge of vertebral bodies, the injection was stopped and the injection needles were adjUsted to the anterior part, and then the contrast media was injected gradually again. Results Extravasation of bone cement into the vertebral canal did not occurred to the 19 vertebral bodies which had extravasation Of contrast media into vertebral canal. Conclusion The gradually percutaneous vertebroptasty is an effective and feasible melhod to prevent extravasation of bone cement.