椎体成形术在脊柱神经外科中的应用

Application of vertebroplasty in spinal neurosurgery

目的 探讨椎体成形术在脊柱神经外科中的临床应用.方法 回顾性分析2012年6月至2015年5月南京军区南京总医院神经外科收治的40例应用椎体成形术（包括35例经皮手术和5例开放式脊柱手术中联合应用两种方式）治疗脊柱疾病患者的临床资料,分析和评价椎体成形术在脊柱神经外科中的应用效果.结果 本组40例患者共58个椎体注入骨水泥,5例患者的5个椎体联合应用开放式脊柱手术,均效果良好;35例患者的53个椎体采用经皮手术,其中有7例患者的7个椎体发生骨水泥渗漏,除1例放弃进一步治疗外,其余患者经治疗后均有好转.38例随访6～36个月（平均15.4个月）,26例血管瘤和骨质疏松的患者效果良好,1例多发性骨髓瘤、6例转移癌疼痛缓解,3例转移癌、1例脊柱原发性肿瘤和1例多发性骨髓瘤1年后死于原发疾病的进展.结论 椎体成形术具有操作简单、学习曲线短、疗效肯定等优点,非常适合于高龄、体质较弱等无法实施全麻手术的患者,在脊柱开放式手术中联合应用,能同时解决多个脊柱疾病.

Objective To investigate the clinical application of vertebroplasty in spinal neurosurgery. Methods From June 2012 to May 2015, the clinical data of 40 patients with spine disease treated by using vertebroplasty （including 35 cases of percutaneous surgery and 5 cases in combination with 2 ways in open spinal surgery） at the Department of Neurosurgery, Nanjing General Hospital of Nanjing Military Command were analyzed retrospectively. The application effect of vertebroplasty in the spine neurosurgery were analyzed and assessed. Results A total of 58 vertebrae were injected bone cement in 40 patients of this group. Five vertebrae were treated with combined application of open spinal surgery in 5 patients and the efficacy was good; 53 vertebrae were treated with percutaneous surgery in 35 patients. The leakage of cement occurred in 7 vertebrae in 7 patients. In addition to 1 patient gave up further treatment, others all became well after treatment; 38 patients were followed up for 6 to 36 months （mean 15.4 months）, the efficacy of 26 patients with hemangioma and osteoporosis was good. One patient had multiple myeloma. The pain of 6 patients with metastatic carcinoma was relieved. Three patients with metastases, 1 with primary spinal tumor, and 1 with multiple myeloma died of the progress of primary disease 1 year later. Conclusions Vertebroplasty has the advantages of simple operation, short learning curve, and curative effect etc. It is best adapted for the elderly, weaker constitution, and other patients who can not be implemented in general anesthesia. It can simultaneously address multiple spinal diseases in the combined application of open spine surgery.