新型Vessel—X经皮椎体强化系统在脊柱微创治疗的临床应用

Clinical research of minimally invasive spine surgery with Vesselplasty

目的观察新型Vessel—X经皮椎体强化系统（Vesselplasty）在微创治疗骨质疏松性椎体骨折和椎体转移瘤的有效性和安全性。方法回顾性分析2010年6月至2016年12月首都医科大学附属北京友谊医院骨科采用Vesselplasty治疗脊柱疾病81例患者，包括骨质疏松性椎体骨折和椎体转移瘤。记录椎体骨折患者一般资料，测量手术椎体Cobb’s角，对比术前、术后3d及6个月随访视觉模拟评分法（VAS）及Cobb’s角度变化，比较术前、术后6个月随访Oswestry功能障碍指数（ODI评分）变化；记录手术时间，并通过术后CT观察骨水泥渗漏情况。记录椎体转移瘤患者一般资料，比较术前、术后3dVAS评分，记录手术时间，通过术后CT观察骨水泥渗漏情况。结果所有患者均安全完成手术，无严重并发症发生。所有患者术后疼痛明显缓解甚至消失，VAS评分由术前（7．8±0．9）降至术后（2．3±0．7）（P〈0．05）。椎体骨折患者49例，年龄（70．2±8．2）岁，手术椎体58个，其中椎体后壁破损者16例，每个椎体手术时间为（16．2±4．6）min，术后VAS和ODI评分变化差异有统计学意义（P〈0．05）；术椎Cobb’s角由术前（13．9±6．0）。降至术后（5．2±4．0）。（P〈0．05）；且随访6个月后，效果依旧满意。椎体转移瘤患者32例，年龄（69．6±11．1）岁，手术椎体共38个，椎体后壁破损者22个，每个椎体手术时间为（17．6±5．4）min，术后VAS评分降低均差异有统计学意义（P〈0.05）。共4例患者4个椎体发生少量骨水泥渗漏，骨水泥渗漏率4．2％，且均无临床症状。结论Vesselplasty可以安全、有效地治疗骨质疏松性椎体骨折和椎体转移瘤，不仅止痛效果满意，部分恢复骨折椎体高度，同时骨填充网袋可以降低骨水泥渗漏风险，为脊柱微创治疗提供新的方案和选择。

Objective To evaluate the efficacy and safety of Vesselplasty in the treatment of osteopemtic vertebral fractures and vertebral metastases. Methods From June 2010 to December 2016, data of 81 patients with spinal diseases treated with Vesselplasty in Department of Spinal Surgery, Beijing Friendship hospital, Capital Medical University were retrospectively analyzed. There are 49 cases of vertebral fractures with age （70. 2 ±8.2） years. Among them, 16 cases have posterior vertebral wall breakage, but no symptoms of nerve injury. Clinical result were evaluated with Visual Analogue Scale （VAS） , the kyphotic angle （Cobb＇ s angle） and Oswestry disability index （ODI） was measured preoperatively, postoperatively and follow-up. At the same time, the operation time and cement leakage were recorded. There were 32 patients with vertebral metastases, with age of （69. 6 ± 11.1 ） years old. The posterior wall of the vertebral body was damaged in 22 cases. The VAS scores were recorded and compared preoperatively and postoperatively. The operation time was recorded also. Results All patients were completed the operation safely and with no complications. Compared with preoperative VAS, postoperative VAS was significantly decreased in all subjects（P 〈 0. 05 ）. The average operation time of each vertebral body was 16. 2 ± 4. 6 min, and the postoperative VAS score significantly decreased （P 〈 0.05）, Cobb＇s angle from preoperative （13.9 ±6.0）° to（ 5.2±4. 0） ° （P 〈0. 05） in 49 cases of vertebral fracture（58 vertebrae）. The clinical resnhs were still satisfied in follow-up . In 32 eases of vertebral metastases （38 vertebrae） , the average operation time was （ 17. 6 ± 5.4） min. The postoperative VAS seore was obviously decreased also （ P 〈 0.05 ）. A small amount of bone cement leakage occurred in 4 cases of 4 vertebrae. The rate of bone cement leakage was 4. 2% , but there were no clinical symptoms in these cases. Conclusion Vesselplasty is a safe and effective treatment of osteopnrotie vertebral fraetures and vertebral metastases. It ean lead to satisfactory clinical effect, partial recovery of vertebral height. Besides, the bone filling mesh can reduce the risk of bone cement leakage, which can provide a new ehoiee for minimally invasive treatment of vertebral fracture and metastases.