后路减压内固定联合椎体成形术治疗症状性椎体血管瘤

Posterior laminectomy and fixation combine with percutaneous vertebroplasty in the treatment of symptomatic vertebral hemangioma

目的探讨后路椎板减压内固定联合椎体成形术治疗症状性胸、腰椎体血管瘤的临床效果。方法选取2009年3月至2011年6月收治的18例症状性椎体血管瘤患者,男8例,女10例;年龄28~65岁,病程11~26个月,平均16.3个月。所有患者均为单椎体血管瘤,其中胸椎7例、腰椎11例。均采用后路减压、内固定植入、椎体成形术,术后以疼痛视觉模拟评分（VAS）及Frankel分级评定患者局部疼痛缓解及神经功能的恢复情况。结果所有手术均顺利完成,未发生脊髓及神经损伤。术中共3节椎体发生骨水泥渗漏,但未出现不适症状。18例患者均获随访,随访时间11~25个月,平均18.3个月,患者症状均有不同程度改善,术后1周及末次随访时VAS评分均较术前明显降低（P〈0.05）。末次随访时Frankel分级：B级1例,C级2例,D级7例,E级8例（P〈0.05）。随访中内固定物无松动、移位,血管瘤无复发。结论后路椎板减压内固定联合椎体成形术是治疗症状性椎体血管瘤的有效术式,在改善神经功能的同时可有效减轻局部疼痛症状。

Objective To evaluate the therapeutical effects of posterior laminectomy and fixation combine with percutaneous vertebroplasty（PVP） in the treatment of symptomatic spinal vertebral hemangioma.Methods A retrospective analysis was performed in 18 patients（8 males and 10 females,aged 28 ~ 65 years,averaged 45.8 years） who had thoracic or lumbar vertebral hemangioma（VH） accepted posterior laminectomy and fixation combine with PVP.All patients had single vertebral hemangioma,7 cases at thoracic and 11 cases at lumbar.The postoperative curative effect was measured by visual analogue scale（VAS） and Frankel grading system.Results No spinal cord and nerves injury occurred during the operation.Three cases of cement leakage occurred,but without any symptoms.All cases received an average follow-up of 18.3 months,the symptoms were improved at different degrees.Compared with the preoperative level,the VAS and Frankel grading system had a significant recovery after the surgery（P 0.05）.No internal fixation loosening and shift happened and without vertebral hemangioma recurred.Conclusions Posterior laminectomy and fixation combine with PVP is an effective method in treating symptomatic vertebral hemangioma.It can improve the neurological function and reduce the local pain effectively.