经皮穿刺椎体成形术治疗症状性颈椎血管瘤

Treatment of cervical hemangioma with percutaneous vertebroplasty

目的探讨经皮穿刺椎体成形术（PVP）治疗颈椎血管瘤的临床效果及注意事项。方法症状性颈椎血管瘤患者共7例（9个椎体）。在C型臂透视下行经皮椎体成形术，使用直径为2．5mm穿刺针，6例C2～6椎体采用仰卧位，经颈椎前外侧入路穿刺；1例C7椎体采用俯卧位，经椎弓根基底途径穿刺。在透视下缓慢地注射甲基丙烯酸甲酯（PMMA）。术后摄片及CT了解骨水泥分布，记录术前、术后及随访时并发症情况，采用术前疼痛视觉模拟评分（VAS）评估疼痛强度。结果本组7例9个椎体均获成功’。随访6～24个月，平均13．6个月，VAS评分，术前（7．3±2．3）分，术后（2．1±1.2）分，随访时（2．3±1．6）分。术后较术前疼痛明显缓解（P〈0．05），随访时维持术后水平（P〉0．05）。无术椎塌陷和新发骨折，无血管瘤复发。椎前方骨水泥外漏2个椎体，1例漏出量大，术中立即取出，均无症状。所有病例术中及术后随访，无并发症发生。结论经皮穿刺椎体成形术治疗症状性颈椎血管瘤是一种安全有效的方式。术中需仔细操作，以防止并发症发生。

Objective To evaluate percutaneous vertebroplasty（PVP） treatment of the clinical effect of cervical hemangioma and precautions. Methods Symptomatic patients with cervical hemangioma in 7 cases（9 vertebrae）. Under the guidance of C-arm fluoroscopy in percutaneous vertebroplasty,with the diameter of 2.5mm needle, 6 cases underwent penetration with anterolateral approach in supine position; 1 case（C7） underwent penetration with interpediculate approach in prone position. X-ray and CT after operation to comprehend the distribution of bone cement,recording preoperative and postoperative and follow-up complications,the use of VAS to assess pain intensity. Results 7 cases（9 vertebrae） were successful. Follow-up 6-24 months,mean 13.6 months, preoperative VAS was 7.3 ± 2.3, postoperative VAS was 2.1± 1.2,2.3 ± 1.6 at follow up. Pain was relief obviously after operation（P〈0.05） ,follow-up maintain the level of postoperative（P〉0.05）. No vertebral collapse and new compression,no hemangioma recurrence. Vertebral bone cement leakage in front of 2 vertebrae,large amount of bone cement leakage in 1 case,immediately removed it,both were asymptomatic, All cases preoperative and postoperative and follow-up,no complication. Conclusion Pereutaneous vertebroplasty in the treatment of symptomatic cervical hemangioma is a safe and effective way. Be careful the operation to prevent complications.