多椎体病变一次性经皮穿刺注入骨水泥椎体成形31例(英文)

Thorax-lumbar vertebrae treated with percutaneous vertebroplasty once only in 31 patients

背景:老年性骨质疏松、骨髓瘤和转移性肿瘤时往往发生多个椎体的病变和压缩,但文献对多发性椎体病变的成型治疗报道较少。目的:探讨多椎体胸腰椎病变一次性经皮穿刺注入骨水泥椎体成形的治疗效果和相关材料与宿主反应的注意事项。设计、时间及地点:观察性试验,病例来自2004-11/2008-10十堰市太和医院脊柱外科、康复科和肿瘤科等。对象:选择十堰市太和医院脊柱外科、康复科、肿瘤科等收治的老年性骨质疏松合并压缩性骨折、多发性骨髓瘤和溶骨性转移性肿瘤患者31例,男14例,女17例;年龄56～82岁。方法:对31例2个以上椎体异常的患者进行一次性经皮穿刺椎体成形术。局麻下先后采用椎弓根入路穿刺病变椎体,在严密监测下依次向各病变椎体内加压注射骨水泥,术后观察椎体内骨水泥注入情况和患者的反应,术后1周评价治疗效果。主要观察指标:一次性椎体成形的数目,椎体穿刺成功率,骨水泥注射量、椎体内骨水泥分布情况,骨水泥向椎旁软组织和静脉泄漏情况,疼痛缓解及有无并发症发生。结果:共进行33次75个椎体的成型治疗,最少1次2个椎体,最多1次5个椎体,平均1次进行2.27个椎体成型;各椎体内骨水泥注射剂量4～12mL,平均7.5mL,椎体内骨水泥均匀充填49个,部分充填椎体者26个;注入骨水泥中未发生明显并发症,所有患者术后局部疼痛缓解,其中明显缓解或消失者20例,部分缓解者11例。结论:经皮穿刺注入骨水泥椎体成形是治疗椎体病变有效而安全的方法,多椎体一次性成形治疗要求合理的骨水泥注射方法和剂量以及严密的治疗过程中的监测。

BACKGROUND： Pathological change and compression of multiple vertebra often occur following senile osteoporosis, myeloma and metastatic tumor. However, there are few studies concerning treatment of multiple vertebral lesion shaping. OBJECTIVE： To explore therapeutic efficacy, announcements of multiple pathological thorax-lumbar vertebrae treated with once only percutaneous vertebroplasty （PVP）. DESIGN, TIME AND SETTING： The observational experiment. Patients were selected from the Department of Spinal Surgery, Department of Rehabilitation, and Department of Tumor, Taihe Hospital from November 2004 to October 2008. PARTICIPANTS： A total of 31 patients from the Department of Spinal Surgery, Department of Rehabilitation, and Department of Tumor, Taihe Hospital with senile osteoporosis combined with compression fracture, general lymphadenomatosis of bones and osteolytic metastatic tumor, 14 males, 17 females, with an age of 56-82 years old. METHODS： Thirty-one cases of multiple pathological thorax-lumbar vertebrae were treated with PVP. Following local anesthesia, affected vertebral body underwent vertebrae root puncturation. Under strict monitoring, bone cement was injected into the vertebral body in order. Following surgery, vertebral body condition and patients＇ reaction were observed. Therapeutic efficacy was evaluated 1 week following surgery. MAIN OUTCOME MEASURES： The following parameters were measured： centrum puncture success ratio, disposable centrum forming number, bone cement injection quantity, centrum bone cement distribution situation, leakage of bone cement to soft tissue and vein surrounding the vertebra, ache alleviation, and complications. RESULTS： A total of 75 vertebroplasy was used 33 times, 2 vertebral bodies at least once only, and 5 vertebral bodies at most once only, with an average of 2.27 vertebral bodies once only. 4 12 mL of bone cement was injected in each vertebral body, averagely 7.5 mL. Uniformity injection was done in 49 cases, and partial injection in 26 cases. Without serious complications, all the patients relieved in local pain parts following surgery. Significant remission or disappearance was determined in 20 cases, and partial remission in 11 cases. CONCLUSION： PVP is a safe and effective method in treatment of multiple pathological thorax-lumbar vertebrae. The key of operation is reasonable injection and thorough monitoring.