椎体成形术中是否有必要行骨静脉造影

If Intraosseous Venography is Necessary Before Injection of Polymethylmethacrylate in Percutaneous Vertebroplasty

目的探讨在椎体成形术中是否有必要行椎体骨静脉造影。资料与方法回顾性分析533例患者共779节椎体成形,分为两组:组1为先行椎体骨静脉造影后再注入骨水泥(PMMA)共247例362节椎体,包括骨质疏松性椎体压缩骨折135例177节椎体、椎体转移性肿瘤112例185节椎体;组2为直接注入PMMA共286例417节椎体,包括骨质疏松性椎体压缩骨折194例288节椎体、椎体转移性肿瘤92例129节椎体。PVP后1天均作CT复查观察PMMA分布及有无椎体周围渗漏。比较两组近期疗效、PMMA渗漏情况、注入量、手术成本及术中X线辐射时间。结果两组病例在性别、年龄、疼痛程度、病变部位、疾病种类及穿刺操作等方面无显著性差异。组1有效为214例(86.6%),组2为258例(90.2%)(P=0.995);组1椎体周围PMMA渗漏为41节,组2为53节(P=0.995);组1平均注入PMMA量为3.74ml,组2为4.06ml(P<0.01);组1平均手术费用为6.77千元/节,组2为5.72千元/节(P<0.01),组2比组1节省约1.05千元/节;组1平均X线照射时间为12.93min,组2为8.81min(P<0.05),组2比组1减少约4.1min。结论椎体骨静脉造影不能提高PVP疗效和安全性,相反增加了手术成本和X线照射时间。

Objective To determine whether antecedent intraosseous venography is necessary in percutaneous vertebroplasty （PVP） procedures. Materials and Methods Retrospective review of 533 consecutive patients with 779 vertebrae treated with PVP at our institution were divided into two groups. In group 1,362 vertebrae in 247 patients , included 135 patients with 177 osteoporotic vertebral compression fractures and 112 patients with 185 vertebral metastases, underwent antecedent intraosseous venography before injection polymethylmethaerylate （PMMA）. In group 2, 417 vertebrae in 286 patients, included 194 patients with 288 osteoporotic vertebral compression fractures and 92 patients with 129 vertebral metastases, underwent injection PMMA without prior intraosseous venography. CT was done one day after PVP to observe PMMA distribution in vertebrae and whether leakage occurred. Clinical outcomes, leakage of PMMA, volume of PMMA injected, expense and X-ray exposure times in each vertebral body, were compared in the two groups. Results No significant difference was seen between the groups with respect to age, sex, the number of treated vertebrae, or preproeedural degrees of pain. At a week after PVP, 214 （ 86.6% ） in group 1 and 258 （90.2%） in group 2 achieved adequate pain relief （P 〉 0.995 ）. 41 vertebrae in group 1 and 53 vertebrae in group 2 with asymptomatie PMMA leakage were demonstrated by CT （P 〉 0.995 ）. The mean volume of PMMA injected in each vertebra was 3.74 ml in group 1 and 4.06 ml in group2 （ P 〈 0.01 ）. The mean expense of each vertebra was ￥6770 in group 1 and ￥5720 in group 2 （P 〈 0.01 ） with ￥1050 cheaper in group 2 than group 1. The mean X-ray exposure times on each vertebral body was 12.93 minutes in group 1 and 8.81 minutes in group 2 （ P 〈 0.01 ） , the mean decrease was 4.6 minutes in group 2 than group 1. Conclusion Antecedent intraosseous venogTaphy does not significantly improve the effectiveness or safety of PVP performed by qualified, experienced operators. On the other hand, it increases the expense and X-ray exposure times of PVP.