改良法经皮椎体成形术治疗骨质疏松性椎体重度压缩骨折

Improved percutaneous vertebroplasty for severe osteoporotic vertebral body compression fractures

目的探讨改良法经皮椎体成形术(PVP)治疗骨质疏松性椎体重度压缩骨折的可行性、疗效及椎体高度的变化。方法回顾性分析应用改良法PVP治疗的36例骨质疏松症患者并46节重度压缩骨折椎体的临床及影像学资料。患者术前接受二维CT及MR检查。术中采用单侧跨中线穿刺,注射骨水泥前摒弃椎体骨静脉造影。术后1日复查二维CT。于CT矢状面图像测量椎体高度,并比较PVP术前及术后椎体前缘、中央和后缘的高度变化。结果 36例患者采用单侧跨中线穿刺治疗全部成功,椎体前缘、中央、后缘恢复高度分别为(2.37±2.10)mm、(2.61±2.21)mm、(0.23±0.44)mm。随访1～29个月,完全缓解(CR)、部分缓解(PR)和无效(NR)例数分别为27例、8例、1例,总有效率为97.22%。结论改良法PVP治疗骨质疏松性椎体重度压缩骨折可行、有效,可提高压缩椎体的高度。

Objective To observe the feasibility,efficacy and degree of changes in vertebral body height in patients with severe osteoporotic vertebral body compression fractures after improved percutaneous vertebroplasty （PVP）.Methods A retrospective analysis of 36 cases with 46 severe vertebral body compression fractures treated with improved PVP was performed.The improvement for PVP included puncture using an approach straddle median line to get rid of antecedent intraosseous venography before injection of polymethylmethacrylate.Two-dimensional CT and MR examination were performed before operation,and two-dimensional CT was performed again 1 day after operation.Vertebral body height was measured on sagittal plane CT.Height changes of the anterior,central and posterior vertebral body measured before and after PVP were compared respectively.Results Successful puncture was obtained in all patients with an approach straddle median line.The restore height of anterior,central and posterior vertebral body was （2.37±2.10）mm,（2.61±2.21）mm and （0.23±0.44）mm,respectively.All the cases were followed-up for 1—29 months,complete remission （CR）,partial remission （PR）0 and no remission （NR） was 27 cases,8 cases,and 1 case,respectively.The total effective rate was 97.22%.Conclusion Improved PVP is an effective and feasible technique for severe osteoporotic vertebral body compression fractures.It can raise height for severe osteoporotic vertebral body compression fractures.