O-arm导航经皮椎体成形术治疗症状性椎体血管瘤

O-arm-guided Percutaneous Vertebroplasty in the Treatment of Symptomatic Vertebral Hemangioma

目的：探讨应用O-arm导航系统行经皮椎体成形术（ percutaneous vertebroplasty ，PVP）治疗症状性椎体血管瘤的安全性和疗效。方法选取2014年1月～2015年7月应用O-arm导航系统行PVP 9例（11椎）症状性椎体血管瘤临床资料。男3例，女6例，年龄（54．7±11．0）岁（36～70岁）。记录手术时间、骨水泥注射量、术后并发症。术后第2天复查X线及CT评估骨水泥渗漏情况。比较术前、术后第2天及末次随访病椎椎体高度。术前及术后3天、末次随访用视觉模拟评分（ visual analogue scale，VAS）评估疼痛情况。结果单侧椎弓根注射骨水泥7个椎体，双侧椎弓根注射骨水泥4个椎体，每椎骨水泥注射量（3.3±0．7）ml（2．5～4．5 ml），每椎手术时间（38．2±8．1）min（30～50 min）。术后第2天X线、CT显示骨水泥填充病灶良好，分布均匀，1例有病椎前缘少量骨水泥渗漏。均未出现神经损伤、肺栓塞等并发症。术后随访（6．6±4．2）月（3～15个月），未发现病椎塌陷和肿瘤复发。术后VAS评分逐渐下降，术前VAS评分（5．9±0．8）分，术后第3天（2．4±1．1）分，末次随访（0．4±0．7）分，两两比较均存在统计学差异（P＜0．05）。术前、术后第2天及末次随访病椎椎体高度均无统计学差异（P＞0．05）。结论应用O-arm导航系统可达到精确经皮穿刺，在其导航下行PVP治疗症状性椎体血管瘤是一种创伤小、安全有效的方法。

Objective To evaluate the effectiveness of O-arm-guided percutaneous vertebroplasty （ PVP） in the treatment of symptomatic vertebral hemangioma （VH）. Methods A retrospective study was conducted on 9 consecutive patients （3 males and 6 females;mean age, 54.7 ±11.0 years old） with symptomatic VH who underwent O-arm-guided PVP procedures, for a total of 11 affected vertebral levels , from January 2014 to July 2015.The operative time , dose of cement and postoperative complications were recorded.Cement leakage was evaluated by X-ray and CT scan on the 2nd day postoperatively .Meanwhile, the changes of preoperative and 2nd day postoperative and final follow-up vertebral body height were compared .The clinical effects were evaluated with the visual analog scale （ VAS） before surgery , 3 days after surgery and at final follow-up. Results PVP was successfully performed under O-arm guidance via a unipedicular approach in 7 levels and a bipedicular approach in 4 levels.The mean dose of bone cement was （3.3 ±0.7） ml （range, 2.5 -4.5 ml）, and the mean operative time was （38.2 ±8.1） minutes （range, 30 -50 min）.Post-operative X-ray and CT scan indicated that the bone cement filling was uniformly distributed .However, we found paravertebral cement leakage in 1 case without any onset of radicular symptoms related to epidural diffusion .No pulmonary embolism occurred and no clinical and symptomatic complications were observed .No vertebral collapse or recurrence of hemangioma was found after （6.6 ±4.2） months （rang,3-15 months） of followed-up.The VAS scores were significantly decreased from （5.9 ±0.8） points preoperatively to （2.4 ±1.1） points on the 3rd day postoperatively, with a final score of （0.4 ±0.7） points （P〈0.05）.No significant differences were found among the preoperative, 2nd day postoperative, and final follow-up in the height of diseased vertebra （P〉0.05）. Conclusions O-arm-guided PVP allows for accurate vertebral body access and cement deposition .As a minimally invasive procedure , it provides an effective and safe technique in the treatment of symptomatic VH .