椎体静脉造影在PVP治疗合并椎体真空征骨质疏松性胸腰椎骨折中的应用

Application of vertebral body venography in percutaneous vertebroplasty for treatment of osteoporotic thoracolumbar fractures combined with vertebral vacuum syndrome

目的探讨椎体静脉造影在经皮椎体成形术（PVP）治疗伴有椎体真空征的骨质疏松性胸腰椎骨折中的应用。方法回顾性分析自2010—02—2015—02采用PVP治疗的73例（73个椎体）椎体内真空裂隙骨质疏松性胸腰椎骨折。术中行椎体静脉造影后注射骨水泥。观察造影剂的渗漏情况及其在椎体内的分布特征，记录术中骨水泥注入量，比较术前、术后1个月、术后1年的VAS评分及ODI指数。结果术中椎体静脉造影后透视显示66例（90．4％）造影剂均在椎体内、裂隙内填充；7例（9．6％）有造影剂渗出，其中3例为椎体周围渗漏，2例为椎间盘渗漏，2例为椎管内渗漏。骨水泥注入量3．1，5．5ml，平均4．2ml。本组均获得随访12，24个月。平均18个月。术后1个月、1年的VAS评分及ODI指数较术前明显降低，差异有统计学意义（P〈0．05）。术后1年与术后1个月的VAS评分、ODI指数比较差异无统计学意义（P〉0．05）。结论PVP治疗伴有椎体真空征的骨质疏松性椎体骨折术中行椎体静脉造影能够预见骨水泥流动分布特征以减少骨水泥的渗出．提高手术安全性。

Objective To explore the application of vertebral body venography in percutaneous vertebroplasty（PVP） for treatment of osteoporotic thoracolumhar fractures combined with vertebral vacuum syndrome. Methods Seventy-three cases （73 vertebral bodies） of osteoporotic thoracolumbar fracture treated by PVP from February, 2010 to February 2015 were retrospectively analyzed. Vertebral body venography was performed followed by injecting bone cement in operation. The leakage of contrast agent and its distribution in the vertebral body were observed and the bone cement injection volume was recorded. The VAS score and ODI index before operation and 1 month, 1 year after operation were compared. Results Intraoperative fluoroscopy showed that 66 cases（90.4%） were filled with contrast agent in the vertebral body and the fissure, 7 cases （9.6%） had the contrast agent exudation, 3 cases had the vertebral leakage. 2 cases had intervertebral disc leakage, 2 cases had spinal canal leakage. Bone cement injection volume was 3.1-5.5 ml, an average of 4.2 ml. All the patients were followed up for 12-24 months, an average of 18 months. The VAS score and ODI index 1 month, 1 year after operation were significantly lower than that before surgery, and the difference was statistically significant （P 〈0.05）. There was no significant difference in VAS score and ODI index between 1 year and l month after surgery （P 〉0.05）. Conclusion Vertebral body venography in percutaneous vertebroplasty for treatment of osteoporotic thoracolumbar fractures combined with vertebral vacuum syndrome may help to reduce the leakage of bone cement and improve the safety of operation.