经皮椎体成形术的临床应用及进展

Percutaneous vertebroplasty:clinical application and development

目的总结经皮椎体成形术的临床应用方法和效果。方法自2005年8月～2008年8月应用经皮椎体成形术治疗骨质疏松症椎体压缩性骨折和椎体肿瘤22例患者25个椎体,在C臂机正侧位方向监视下用13G骨穿针经单侧椎弓根穿刺至椎体前中1/3,注入聚甲基丙烯酸甲酯骨水泥3～5mL。结果本组全部患者术后第1 d疼痛缓解程度根据VAS评分与术前相比有显著性差异（P〈0.01）,可戴腰围自行或搀扶下地。1例出现骨水泥椎间隙及椎前缘渗漏,无临床症状,未做处理;1例术后出现不明原因精神症状,精神科会诊诊断为反应性精神分裂症,转精神科治疗1 w后恢复正常出院。结论PVP的技术难点在于准确地穿刺、骨水泥注入时机的掌握,PVP的新发展与新型充填物的研发将会使其治疗脊椎病变具有广阔应用前途。

Objective To summarize the clinical methods and effectiveness of percutaneous vertebmplaty. Methods Tweenty-two cases（25 vertebral bodies） with Osteoporotic vertebral compression fractures and vertebral tumors were treated by percutaneous vertebroplaty from August 2005 to August 2008. 3 - 5 mL bone cement was injected after the puncture needle was inserted into the fractured vertebal body transpedicularly under ＂C＂ arm imaging guiding. Results Pain relieved of all patients was significantly different （ P 〈 0.01 ） according to the VAS scale as compared with postoperation in the following day, the patients were allowed to get off bed. There was 1 patient with a small quantities of paravertebral leavages with no symptoms. Another patient had unknown psychological symptom, he was treated in psychological department and was discharged after l week with no symptons. Conclusions The techonical difficulty of percutaneous vertebroplaty is accurate accupuncture and in controle of timing of bone cement injection. The percutaneous vertebroplaty has wider applied future for cure of spinal diseases with the development of PVP and new type of fillings.