经皮椎体成形修复症状性椎体血管瘤:骨水泥操作技术

Percutaneous vertebroplasty in the treatment of vertebral hemangioma: bone cement operation

背景:尽管已有多篇文献报道使用经皮椎体成形骨水泥注射治疗血管瘤具有微创、出血少、操作简单、恢复快、止疼迅速等优点及治疗有效性,但人们对其治疗后的肿瘤复发、症状改善、骨水泥渗漏等并发症及安全性仍存在疑虑。目的:探讨和总结采用经皮椎体成形骨水泥注入治疗有症状性椎体血管瘤的临床疗效及安全性。方法:纳入有明确症状且诊断为椎体血管瘤的患者52例,其中男21例,女31例,年龄16-63岁,T5-T12椎体血管瘤36例,L1-L3椎体血管瘤16例。所有患者均行椎体成形骨水泥注入治疗,对比治疗前后的目测类比评分、OSWESTRY功能障碍指数、MacN ab疗效及并发症等指标。结果与结论:52例患者均获得6个月随访,治疗后1 d、3周、6个月的目测类比评分与OSWESTRY功能障碍指数均明显优于治疗前(P<0.05);MacN ab疗效评价显示,优40例,良7例,可3例,差2例,优良率为90%;1例患者在治疗后6个月时出现肿瘤复发,1例在手术中出现无症状性骨水泥渗漏,余无明显并发症出现。表明经皮椎体成形骨水泥注入可有效治疗椎体血管瘤且相对安全,能够明显减轻疼痛。

BACKGROUND：Increasing studies have found that, percutaneous vertebroplasty and bone cement are characterized by few traumas, few bleeding, simple operation, rapid recovery, rapid pain relief, and effective efficacy. However, tumor recurrence, symptom improvement, bone cement leakage and other complications make people controversial. OBJECTIVE： To explore and summarize clinical outcomes and safety of percutaneous vertebroplasty and bone cement for treating symptomatic vertebral hemangioma. METHODS：Fifty-two cases patients of symptomatic vertebral hemangioma （including 21 male and 31 female, aged 16-63 years） were treated with percutaneous vertebroplasty and bone cement. The lesions were found at T5-T12 in 36 cases and at L1-L3 RESULTS AND CONCLUSION： Al 52 patients were folowed up for at least 6 months after the operation. The Visual Analogue Scale and Oswestry Disability Index were significantly increased at 1 day, 3 weeks and 6 months post-surgery, when compared to before surgery （P〈 0.05）; the modified Macnab evaluation was excelent in 40 cases, good in 7 cases, fair in 3 cases, and poor in 2 cases, and the excelent and good rate was 90%. Only one patient had recurrence at 6 months after surgery and one patient had the leakage of bone cement. No other complications were found. Percutaneous vertebroplasty and bone cement could effectively cure vertebral hemangioma and relieve the pain, which is a safe treatment. in 16 cases. Clinical outcomes such as Visual Analogue Scale, Oswestry Disability Index and modified Macnab criteria, as wel as complication before and after surgery were evaluated.