经皮椎体成形术治疗椎体血管瘤

Treatment of vertebral hemangioma with percutaneous vertebroplasty

目的探讨经皮椎体成形术(PVP)治疗椎体血管瘤(VH)的疗效。方法 18例胸腰椎VH患者累及椎体共22个(胸椎8个,腰椎14个),除1例不全截瘫患者(FrankelC级)外均采用经皮椎弓根入路,19个椎体双侧椎弓根、2个椎体单侧椎弓根注射。透视下骨水泥注入治疗,1例ⅣB型VH辅以无水乙醇注入,1例截瘫患者给予后路切开减压、骨水泥置入、椎弓根螺钉固定。观察疼痛和椎体形态的变化。结果 18例均获随访,时间9个月～3年,平均(23.33±8.02)个月。14例疼痛即刻缓解;1例2d缓解;1例ⅣA型VH术后神经症状明显缓解,6个月时神经症状基本消除;1例术后症状部分缓解,仍有下腰痛,3个月后给予椎间盘造影后,L4～5椎间隙能诱发明显下腰痛,行后路椎间盘摘除、椎间融合器融合、椎弓根内固定,症状完全缓解。1例不全截瘫者3个月后逐步弃拐行走,神经恢复达FrankelE级。未见再发病例。结论 PVP治疗VH可获得即刻稳定和疼痛很快缓解的效果。

Objective To investigate the efficacy of percutaneous vertebroplasty（PVP）in the treatment of vertebral hemangioma（VH）.Methods 18 patients with vertebral hemangiomas were treated by percutaneous vertebroplasty on 22 vertebral bodies,of which there were 8 cases of thoracic,and 14 cases of lumbar hemangiomas,chronic pain in 14 cases,symptomless in 2 case,neuralgia in 1 case and paraparesis in 1 case（Frankel spinal cord injury scale C）.Percutaneous vertebroplasty consists of the injection of acrylic cement into affection vertebral bodies（19 affection vertebral bodies by double pedicles and 2 bodies by single pedicle）to achieve pain relief and mechanical stability of the spine.Injecting ethanal followed by PVP in 1 case of type ⅣB VH and open operation in the last case.Pain and vertebral shape were observed.Results All cases were followed up for 9~36 months（mean 23.33±8.02 months）to observe pain and shape of vertebra.Pain was completely relieved in 15 cases（include 1 case which was relieved in 2 days）.After PVP of one case of type ⅣA,the neurological symptom was partially relieved,after 6 months the symptom dismissed.In 1 case the symptom was partially relieved,but the patient had low back pain.After 3 months,discography was done,and the L4~5 disc induced low back pain,and then discectomy was performed by posterior approach,with cage fusion,transpedicle fixation,and the symptom was totally relieved.1 case of paraplegina could gradually walk without stick after 3 months.Symptom was also recovered in 1 patient with radiculopathy in 6 months（Frankel spinal cord injury scale E）.No recurrence was found after postoperative follow-up.Conclusions Percutaneous vertebroplasty appears to be an effective technique in the treatment of VH with satisfactory and instantly mechanical stability results.