经皮椎体成形术治疗骨质疏松性椎体压缩骨折

Percutaneous Vertebroplasty for the Treatment of Osteoporotic Vertebral Compression Fractures

目的 探讨经皮椎体成形术 (PVP)治疗骨质疏松性椎体压缩骨折的适应证、椎体造影表现、关键技术、近期疗效及并发症的预防。资料与方法 4 3例骨质疏松症并 5 5节椎体压缩骨折。患者在透视监视下经椎弓根行椎体穿刺 ,所有椎体均用非离子型对比剂行椎体造影 ,注入粉 /液 /对比剂比例为 3∶2∶1的聚甲基丙烯酸甲脂 (poly methylmethacrylate,PMMA) ,术后CT观察PMMA分布状况和有无渗漏 ,并进行临床疗效评价和观察有无并发症发生。结果 PVP技术成功率 10 0 %。椎体造影主要有 4种表现 ,其中独特的征象是对比剂注入压缩骨折椎体内后呈囊状分布并滞留。PMMA平均注入量胸椎 3.3ml,腰椎 4 .5ml。随访 1～ 18个月 ,完全缓解 (CR)、部分缓解 (PR)和无效 (NR)分别为 74 .4 %、2 0 .9%和 4 .7% ,总有效率 95 .3%。CT证实椎体周围PMMA渗漏 5例 ,但无 1例出现临床症状。结论 PVP治疗骨质疏松性椎体压缩骨折安全可行 ;椎体造影有助于预测注射PMMA在椎体内的分布状况和发生渗漏的可能性 ;主要并发症为PMMA渗漏 。

Objective To discuss the indications, technical points, short-term efficacy and the complication prevention of percutaneous vertebroplasty (PVP) for the treatment of osteoporotic vertebral compression fractures, and to study the vertebrographic manifestations.Materials and Methods Forty-three patients had 55 osteoporotic vertebral compression fractures. The diagnosis was confirmed with plain radiograph, CT or MRI. PVP was performed with local anesthesia under CT together with C-arm flouroscopy or only C-arm flouroscopy monitoring. Intraosseous venography was performed on each fractured vertebra by hand injection of nonionic contrast agent after puncture success. Polymethylmethacrylate (PMMA) mixture, with the ratio of powder/liquid/contrast agent as 3∶2∶1, was injected. After the procedure, CT scanning was carried out to observe PMMA distribution in the vertebra and to clarify if there was any leakage of PMMA. The clinical efficacy was evaluated and the observation of complication was made. Results The technical success rate of PVP was 100%. The vertebral venographic manifestations could be classified into 4 patterns, of which the most specific sign was that the injected PMMA remained in the marrow space presenting as saccular form. The average injection dose of PMMA was 3.3 ml for thoracic and 4.5 ml for lumbar vertebra. The patients were followed for 1～18 months. CR, PR and NR were 74.4%, 20.9% and 4.7%, respectively, with a total effective rate of 95.3%. CT confirmed PMMA leakage in 5 cases, whereas, no one occurred any clinical symptoms. Conclusion PVP is a safe and feasible technique for the treatment of vertebral compression fractures due to osteoporosis. The main complication is the leakage of PMMA. The key point to prevent it is to accomplish the injection under the flouroscopy monitoring when the PMMA is still in viscid state.