椎体成形术后椎体高度变化的临床研究

目的 探讨骨质疏松性椎体压缩骨折经皮椎体成形术(PVP)后椎体高度是否能提高.资料与方法 骨质疏松性椎体新鲜压缩骨折40例共68节,其中椎体内合并囊性裂隙12例共16节.应用64层螺旋CT在脊椎二维重组图像的正中矢状面分别测量PVP术前及术后椎体前缘、中央及后缘高度,比较PVP前后椎体高度的变化、与椎体压缩程度关系及合并囊腔裂隙者与无囊腔裂隙者的高度变化差异.结果 PVP后椎体前缘、中央和后缘高度分别提高(2.01±1.72)mm、(1.78±1.47)mm及(0.44±1.03)mm;PVP术后椎体前缘、中央高度增加值与压缩程度呈正相关.椎体内合并囊变者PVP后前缘及中央高度分别提高(4.13±1.88)mm、(3.76±1.51)mm,椎体无囊变者PVP后前缘及中央高度分别提高(1.35±1.01)mm、(1.17±0.75)mm,两组比较差异有统计学意义(P<0.05);椎体有囊变者PVP术中注入骨水泥的量较无囊变者明显增加.结论 PVP可提高多数骨质疏松性椎体新鲜压缩骨折的椎体高度,合并椎体囊变者的高度提高更明显;椎体高度的提高与压缩程度呈正相关.     

经皮椎体成形术治疗骨质疏松性椎体压缩骨折

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 43例骨质疏松症并55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—methylmethaerylate，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100％。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％、20．9％和4．7％，总有效率95．3％。CT证实椎体周围PMMA渗漏5例，但无l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，防止渗漏的关键是必须在PMMA黏稠阶段及透视监视注射。     

椎体成形术和传统法治疗骨质疏松性椎体压缩骨折疗效的对比研究

目的研究并比较椎体成形术(PVP)和保守疗法治疗骨质疏松性椎体压缩骨折的临床疗效。方法骨质疏松性椎体新鲜压缩骨折83例共104节,非随机分为2组,组1共44例58节用PVP治疗,组2共39例46节用保守治疗,比较两组治疗后随访期内疗效及椎体高度变化。结果组1患者44例PVP后1周疼痛均得到缓解,视觉疼痛评分(VAS)平均分值从术前8.5下降至2.6(平均下降5.9)。组2患者39例保守治疗后1周VAS分值无变化,在治疗后1周、1和3个月时。组1的VAS分值明显低于组2(P<0.01),6个月时两组差异无统计学意义(P>0.05)。平均随访8.9个月,组1有新发骨折3例3节,组2有2例2节,两组比较无显著差异无统计学意义(P>0.05)。PVP后1周椎体高度恢复平均为前缘2.2mm,中央2.3mm,后缘高度无变化,随访3、6个月椎体前缘、中央高度与PVP后1周时无差异(P<0.01)。保守治疗后1周椎体前缘、中央及后缘高度与治疗前比较无显著改变,3个月时椎体高度丢失平均为前缘1.9mm,中央2.1mm,6个月时与3个月无差异。在治疗3个月后,组1椎体高度明显高于组2(P<0.01)。结论PVP可迅速缓解疼痛,明显缩短病程,但6个月后两组疗效无显著差异;PVP可使新鲜压缩椎体的前缘和中央高度得到部分恢复,可显著预防椎体进一步塌陷;保守治疗在3个月内椎体高度可进一步丢失;PVP后新发骨折可能是骨质疏松症的自然发病过程。     

椎体成形术中是否有必要行骨静脉造影

目的 探讨在椎体成形术中是否有必要行椎体骨静脉造影.资料与方法回顾性分析533例患者共779节椎体成形,分为两组:组1为先行椎体骨静脉造影后再注入骨水泥(PMMA)共247例362节椎体,包括骨质疏松性椎体压缩骨折135例177节椎体、椎体转移性肿瘤112例185节椎体;组2为直接注入PMMA共286例417节椎体,包括骨质疏松性椎体压缩骨折194例288节椎体、椎体转移性肿瘤92例129节椎体.PVP后1天均作CT复查观察PMMA分布及有无椎体周围渗漏.比较两组近期疗效、PMMA渗漏情况、注入量、手术成本及术中X线辐射时间.结果两组病例在性别、年龄、疼痛程度、病变部位、疾病种类及穿刺操作等方面无显著性差异.组1有效为214例(86.6%),组2为258例(90.2%)(P=0.995);组1椎体周围PMMA渗漏为41节,组2为53节(P=0.995);组1平均注入PMMA量为3.74 ml,组2为4.06 ml(P＜0.01);组1平均手术费用为6.77千元/节,组2为5.72千元/节(P＜0.01),组2比组1节省约1.05千元/节;组1平均X线照射时间为12.93 min,组2为8.81 min(P＜0.05),组2比组1减少约4.1 min.结论椎体骨静脉造影不能提高PVP疗效和安全性,相反增加了手术成本和X线照射时间.     

再次椎体成形术的应用

目的探讨再次经皮椎体成形术(PVP)处理首次PVP术后疼痛不缓解的可行性、方法及疗效。方法骨质疏松症并椎体压缩骨折9例共9节行PVP治疗后疼痛不缓解,其中轻度压缩3例、中度以上压缩6例,包括合并囊性积液4例4节和粉碎性压缩2例2节;椎体转移性肿瘤4例共5节行经皮椎体成形术治疗后2～4个月疼痛复发。均采用再次PVP治疗,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。结果再次PVP技术均成功,再注入PMMA量平均为4．8ml,随访1～18个月,CR10例、PR3例。CT证实椎体周围PMMA渗漏2例,但无一例出现临床症状。2例椎体转移肿瘤分别于再次PVP后4、5个月死亡,但无明显相应病变椎体平面疼痛。结论对骨质疏松性椎体压缩骨折PVP后疼痛不缓解及椎体内转移性肿瘤疼痛复发者,再次PVP的疗效显著。关键技术是经椎弓根穿刺至椎体内致痛区并充分充填PMMA。     

椎体内裂隙样变对椎体成形术治疗椎体压缩骨折疗效的影响

目的 研究经皮椎体成形术(PVP)治疗并存椎体内裂隙样变骨质疏松性椎体压缩骨折的疗效,并与单纯性(不合并椎体内裂隙样变)骨质疏松性椎体压缩骨折的疗效进行对比,以分析椎体内裂隙样变对疗效的影响.方法 回顾性分析PVP治疗95例患者、176节椎体骨质疏松性压缩骨折的临床及影像学资料.本组研究中除外多节段骨折、合并肿瘤病史、影像资料不全和术后随访不配合患者.入选43例分A、B两组,18例骨质疏松性椎体压缩骨折合并裂隙样变患者为A组,25例无椎体内裂隙样变患者为B组.比较两组间术前疼痛和功能障碍情况,分析两组术后1周局部疼痛缓解和功能改善情况;观察两组并发症情况.结果 A组与B组术后1周疼痛缓解及日常活动功能改善明显(P＜0.05);两组间术后1周疼痛缓解的程度和日常活动功能改善的程度差异无统计学意义(P＞0.05);两组间骨水泥外漏发生率相似(P＞0.05),但两组间骨水泥外漏类型分布有差异(P＜0.05).结论 PVP是治疗骨质疏松性椎体压缩骨折的有效方法;椎体内裂隙样变对PVP的止痛疗效、功能改善与骨水泥外漏发生率无明显影响,但对骨水泥的外漏类型有一定影响.     

经皮椎体成形术治疗症状性椎体血管瘤远期疗效分析

目的分析经皮椎体成形术治疗症状性椎体血管瘤的远期疗效。方法17例患者19处椎体血管瘤,13处椎体无压缩骨折,6处椎体已发生压缩骨折。17例患者均诉不同程度胸背部或腰部疼痛,其中5例发生压缩骨折的患者还伴有不同程度的神经功能缺陷(4例)或脊髓受压症状(2例)。在DSA监测下行经皮椎体成形术(PVP)。术后随访6～32个月,平均(15.8±8.7)个月。结果19处血管瘤椎体PVP均获得成功,术中每个椎体注射PMMA2～6ml,4例发生椎旁渗漏,2例发生硬膜外渗漏,但未出现明显的临床症状,1例椎体其上椎间盘发生渗漏。短期随访显示17例患者胸背部或腰部疼痛均有不同程度缓解,2例神经根或脊髓受压患者症状消失,其余3例患者症状仍存在。长期随访示2例患者疼痛加剧,系邻近椎体骨质疏松性压缩骨折引起。结论PVP是治疗症状性椎体血管瘤的一种安全、有效、创伤小的方法,远期疗效可靠。     

36例经皮椎体成形术的临床应用分析

目的 分析经皮椎体成形术(PVP)治疗椎体压缩骨折的临床应用.方法 36例患者(41节责任椎体)采用单侧或双侧入路行PVP,通过术前与术后1周VAS评分以及椎体高度的测量,显示差异有统计学意义(P＜0.01),分析临床疗效和有无并发症.结果 41节责任椎体采用PACS自带软件测量到术前PVP穿刺参数测量值,选择单侧入路14节,双侧入路27节.PVP均按照术前设计方案顺利完成,PVP技术成功率100％.骨水泥注入量(4.0±1.1)ml.术前与术后1周VAS评分有明显差异(P＜0.01),疼痛缓解率97.2％.41节PVP前后椎体前缘和中央测量的和后缘测量的高度变化差异有统计学意义(P分别＜ 0.01和0.05).有8节椎体出现不同形式的骨水泥渗漏,发生率19.5％,骨水泥主要是向椎旁组织、椎间盘及椎静脉丛渗漏,仅出现一过性刺激症状,经对症治疗后均消失.结论 PVP已成为椎体压缩骨折的有效治疗手段,其对疼痛有明显的缓解率,降低了VAS评分.同时可显著恢复压缩椎体高度,加固了椎体,防止椎体进一步塌陷.     

经皮椎体成形术治疗老年骨质疏松性椎体骨折

目的 探讨经皮椎体成形术(PVP)治疗老年骨质疏松性椎体骨折的价值.方法 27例老年骨质疏松症患者共33节椎体骨折,均经MRI、CT及平片证实.在透视监视下经椎弓根行椎体穿刺,注入粉(g)GA955液(ml)GA955硫酸钡粉(g)为15GA95510GA9553的聚甲基丙烯酸甲酯(PMMA),术后即刻摄X线正侧位片,1 d后CT观察PMMA分布渗漏状况,定期观察疗效和椎体高度.结果 PVP技术成功率100%,PMMA平均注入量4.6 ml (2.3～7.5 ml),术后1 d CT证实椎体周围PMMA少量渗漏7节,但无临床症状.术后1 d,所有病例腰背部疼痛明显减轻,平均随访8个月,疼痛均无复发,椎体高度无进一步塌陷.结论 PVP对治疗老年骨质疏松性椎体骨折所致的腰背疼痛是有效的.     

过伸复位联合单侧入路的椎体成形术治疗骨质疏松性椎体压缩骨折

目的观察过伸复位联合单侧入路的经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩骨折的效果。方法术前牵引垫枕,术中利用骨科手术床行过伸复位,再行PVP治疗。在术前、术后3 d、术后12个月随访时进行疼痛视觉评分(VAS),计算术前、术后压缩椎体高度恢复率。结果 16例20个椎体操作成功,骨水泥向椎体前方渗漏5例,侧方渗漏2例,向椎间盘内渗漏2例,无椎体后方渗漏。VAS评分由术前8.5±1.2降低至2.5±1.4,骨折椎体高度恢复率为(40.1±23.5)%。结论过伸复位联合单侧入路的PVP是治疗骨质疏松性椎体压缩骨折的有效方法。     

Increase in vertebral body height after vertebroplasty

BACKGROUND AND PURPOSE: During clinical work, we have seen increases in vertebral body height associated with vertebroplasty, but our literature search revealed no reports as to how often and to what degree those increases occur. The purpose of this study was to document the frequency and degree of changes in vertebral body height after vertebroplasty. METHODS: The heights of 85 vertebral bodies in 37 patients were measured before and after vertebroplasty. In addition, one adjacent vertebral body was measured in each patient as a control. Twenty-six patients had compression fractures in the thoracic spine, and 24 patients had compression fractures in the lumbar spine. Vertebroplasty was performed with a bilateral transpedicular approach by injecting polymethylmethacrylate, under biplane fluoroscopic control. Measurements were performed on preoperative MR images and on postoperative CT sagittal reformations. Anterior, central, and posterior vertebral body height measurements were obtained in the midsagittal plane. RESULTS: The average increase in vertebral body height was 2.5 mm anteriorly, 2.7 mm centrally, and 1.4 mm posteriorly. Thirteen of 85 treated vertebrae remained unchanged. All control vertebral bodies also remained unchanged. CONCLUSION: Vertebral body height often increases during vertebroplasty. The clinical significance of increasing vertebral body height is unknown.     

椎体强化在骨质疏松性椎体压缩骨折中的应用

目的分别以聚甲基丙烯酸甲酯骨水泥（PMMA）和碳酸化羟基磷灰石水泥（CHC）作为椎体强化充填材料,采用椎体成形术和后凸成形术治疗骨质疏松性椎体压缩骨折,观察其临床疗效。方法58例骨质疏松性椎体压缩骨折采用以下4种方法治疗：椎体成形术＋PMMA（11例13个椎体）,椎体成形术＋CHC（23例26个椎体）,后凸成形术＋PMMA（8例8个椎体）,后凸成形术＋CHC（16例19个椎体）。根据术前和术后侧位X线片计算椎体高度压缩率和恢复率、后凸角度和恢复率,并采用VAS（visual analog scale）进行术前和术后疼痛评分。结果所有患者均未出现并发症。后凸成形术椎体高度恢复率和后凸角度恢复率优于椎体成形术。椎体增强材料充填剂量各组间无显著性差异。椎体成形术手术时间明显短于后凸成形术。VAS评分术前各组无显著性差异,术后充填PMMA者优于充填CHC者,术后4周二者间无显著性差异。结论椎体强化是一种微创、安全、有效治疗骨质疏松性椎体压缩骨折的方法,应根据患者的具体情况选择治疗方法和椎体充填材料。     

椎体骨质疏松性骨折两种椎体成形术的疗效比较

 目的 比较经皮椎体成形术(percutaneous vertebroplasty,PVP)和经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗老年骨质疏松椎体压缩性骨折的疗效。方法 选取2017-01至2019-12医院收治的因骨质疏松椎体骨折行PVP或PKP治疗的老年患者共112例(132椎),根据选择术式的不同分为PVP组和PKP组,其中PVP组伤椎68个,PKP组伤椎64个。记录两种不同术式手术前后 VAS 评分、伤椎椎体增加高度、骨水泥注入量、手术时间、骨水泥渗漏情况。结果 PVP 组和PKP组术前和术后1 d的VAS评分比较,差异无统计学意义。PKP组术后修复伤椎高度为(11.5±3.2)mm,明显高于PVP组的(2.1±1.3)mm,差异有统计学意义(P<0.05)。PKP组骨水泥注入量也明显多于PVP组,两组比较差异有统计学意义(P<0.05)。PVP 组术中骨水泥渗漏 23个椎体(33.8%),PKP 组渗漏12个椎体(18.8%),PVP 组并发症高于PKP 组。结论 两种手术方式均能达到很好的止痛效果。但PKP恢复椎体高度上优于PVP,骨水泥注入量多,渗漏率低,临床治疗更有优势。     

Vertebroplasty for osteoporotic fractures with spinal canal compromise

BACKGROUND AND PURPOSE: Percutaneous vertebroplasty can aggravate spinal canal narrowing, especially in patients with preoperative retropulsion. The purpose of this study was to evaluate changes in spinal canal dimension during percutaneous vertebroplasty for osteoporotic fractures with retropulsion. MATERIALS AND METHODS: We reviewed all cases of osteoporotic vertebral fractures treated with vertebroplasty. Twenty-one patients (25 vertebrae) had a retropulsed fragment that compromised the dimension of the spinal canal on preoperative imaging. We measured the degree of retropulsion before and after vertebroplasty to evaluate changes in spinal canal dimension. We also evaluated pain, neurologic status, vertebral body height, and wedge angle. RESULTS: Mean retropulsion was 4.2 mm before and 4.4 mm after vertebroplasty. There was no statistically significant difference (P = .32). Mean increase in vertebral body height was 2.6 mm anteriorly, 1.7 mm centrally, and 0.3 mm posteriorly. Mean decrease in wedge angle was 4.7 degrees. There were statistically significant improvements in height and wedge angle (P < .01). None of our patients developed new symptoms during vertebroplasty or thereafter. Twenty of 21 patients (95%) showed partial or complete immediate pain relief, whereas 1 patient did not improve. CONCLUSION: Vertebroplasty can be performed safely in patients with spinal canal compromise. This procedure can reduce pain, increase vertebral body height, and decrease wedge angle without worsening of retropulsion.     

经皮椎体成形术治疗椎体良恶性病变的临床技术应用探讨

目的：探讨经皮椎体成形术（PVP）在治疗椎体良恶性病变中的技术操作问题。方法：对29例的41个椎体病变共行46侧PVP治疗，包括椎体转移瘤16例，骨质疏松压缩性骨折7例，椎体血管瘤3例，骨髓瘤1例，外伤性压缩性骨折1例及不明原因骨破坏1例。PVP在C形臂X线机或C形臂X线机＋CT组合机监视下进行，骨水泥（PMMA）的粉、液比例为3：2，按椎体计算骨水泥用量为2-8ml。结果：46侧PVP成功45侧（97．8％）。本组疼痛完全缓解（CR）者19例（19／29），部分缓解（PR）者9例（9／29），无效（NR）者1例（1／29）。随访2－11个月无复发。PVP术后无一例椎体塌陷加重或发生新的压缩，无一例发生严重并发症。结论：PVP技术安全可行，对腰椎等多数椎体行PVP只要在C形臂X线机上监视下即可，熟练地掌握PMMA使用方法是PVP技术成功的关键因素。     

Percutaneous Vertebroplasty for Osteoporotic Compression Fracture: Multivariate Study of Predictors of New Vertebral Body Fracture

Purpose To investigate the risk factors and relative risk of new compression fractures following vertebroplasty. Methods Initially, we enrolled 104 consecutive patients with vertebral compression fractures caused by osteoporosis. A total of 83 of the 104 patients visited our hospital for follow-up examinations for more than 4 weeks after vertebroplasty. Logistic regression analysis of the data obtained from these 83 patients was used to determine relative risks of recurrent compression fractures, using 13 different factors. Results We identified 59 new fractures in 30 of the 83 patients: 41 new fractures in vertebrae adjacent to treated vertebrae; and 18 new fractures in vertebrae not adjacent to treated vertebrae. New fractures occurred in vertebrae adjacent to treated vertebrae significantly more frequently than in vertebrae not adjacent to treated vertebrae. Only cement leakage into the disk was a significant predictor of new vertebral body fracture after vertebroplasty (odds ratio = 4.633). None of the following covariates were associated with increased risk of new fracture: age, gender, bone mineral density, the number of vertebroplasty procedures, the number of vertebrae treated per procedure, the cumulative number of vertebrae treated, the presence of a single untreated vertebra between treated vertebrae, the presence of multiple untreated vertebrae between treated vertebrae, the amount of bone cement injected per procedure, the cumulative amount of bone cement injected, cement leakage into the soft tissue around the vertebra, and cement leakage into the vein.     

经皮椎体成形术治疗骨质疏松性椎体骨折疗效观察

目的探讨经皮椎体成形术治疗骨质疏松性椎体压缩性骨折的临床疗效及应用价值。方法36例骨质疏松性压缩性骨折患者45个椎体，在C型臂X线透视下，取俯卧位，经皮穿刺，在病椎注入聚甲基丙烯酸甲酯。术前及术后3d进行疼痛视觉类比评分（VAS评分），并进行统计学分析。结果治疗后36例患者疼痛较治疗前有明显好转，VAS评分差异有统计学意义（P〈0．001）；活动能力也有不同程度改善；部分椎体的前缘和椎体中部高度有一定恢复。结论经皮椎体成形术治疗骨质疏松性椎体压缩骨折止痛效果明显，能很快改善患者的活动能力，早期下床活动。该手术属微创手术，在骨科临床有一定的应用前景。