CT引导下靶区小剂量骨水泥精准注射治疗胸腰椎压缩性骨折

Minidosal bone cement precise injection to the taget area in percutaneous vertebroplasty (PVP) for treatment of osteoporosis vertebral compression fractures guided by CT

[目的]探讨CT引导下靶区小剂量骨水泥精准注射椎体成形术治疗骨质疏松性椎体压缩骨折的方法和疗效。[方法]本组216例共251个伤椎接受手术,CT引导下设计穿刺路径和治疗靶区并穿刺椎体,单侧穿刺232个椎体,双侧穿刺19个椎体。椎体内分次小剂量注射骨水泥,CT扫描观察骨水泥分布情况,术后记录患者视觉模拟疼痛评分（visual analogue scale,VAS）和Oswestry功能障碍指数（Oswestry disability index,ODI）,采用配对t检验进行比较。[结果]CT引导经皮椎体穿刺成功率100%,注入骨水泥1.5-3 ml,平均2.78 ml,10个椎体发生无症状性骨水泥渗漏。术后随访12-26个月,平均16个月,VAS评分术前（8.60±0.11）分,术后1周（3.38±0.22）分、术后6个月（2.39±0.10）分,术前ODI平均（64.26±0.55）分、术后1周（33.78±0.61）分、术后6个月（21.43±0.44）分,两指标术后均与术前有显著统计学差异（P〈0.01）。[结论]CT引导下椎体成形术操作安全、精准,小剂量注射骨水泥不影响疗效,能减少手术并发症。

[Objective]To evaluate the effects of percutaneous vertebroplasty of low-dose bone cement precise injection to the taget area guided by CT in treating osteoporotic vertebral compression fractures.[Method]Total 251 vertebral bodies in 216 cases of vertebral compression fracture were punctured under CT guidance,including 232 vertebral bodies through unilateral puncture and 19 vertebral bodies through bilateral puncture.Low-dose bone cement was injected.Vasual analogic scale（VAS） and Oswestry disability index（ODI） were evaluated preoperatively and at one week and six months postoperatively separately.[Result]The punctures for all 251 vertebral bodies were successful,the amount of bone cement injected into each vertebral body was from 1.5 ml to 3 ml（mean 2.7 ml）.All the cases were followed up from 12 to 26 months with an average of 16 months,pain decreased in all patients,VAS decreased from 8.60 ± 0.11 before operation to 3.38 ± 0.22 at one week postoperatively and 2.39 ± 0.10 at six months postoperatively（P 0.01）,ODI decreased from 64.26 ± 0.55 before operation to 33.78 ± 0.61 at one week postoperatively and 21.43 ± 0.44 at six months postoperatively（P 0.01）.Asymptomatic bone cement leakage was demonstrated by CT in 11 cases.[Conclusion]CT guidance provides accurate needle placement,small doses of bone cement filling does not affect the efficacy and can reduce the complication.