聚甲基丙烯酸甲酯骨水泥结合椎体成形重建非感染性缺血坏死的椎体

摘要 背景：非感染性椎体缺血性坏死是一种较少见的椎体缺血坏死，表现为椎体压缩骨折，国内的报道较少。可能与该病的发病率低对该病认识不足有关。 目的：分析非感染性椎体缺血坏死的特点，观察经皮椎体成形术治疗该病的效果。 方法：回顾分析近5年来经皮椎体成形注入聚甲基丙烯酸甲酯骨水泥治疗12例非感染性椎体缺血坏死的疗效。经皮椎体成形手术均在透视监测下经椎弓根注入聚甲基丙烯酸甲酯骨水泥。采用目测类比评分法评估治疗前后疼痛状况，通过侧位片测量经皮椎体成形术前后椎体前缘和中央的高度。 结果与结论：采用经皮椎体成形术治疗12个非感染性椎体缺血坏死，骨水泥注入量平均为(6.0±1.5) mL，术后疼痛完全或显著缓解10例(83%)，部分缓解2例(17%)。目测类比评分法评分从术前的9.08±0.76降为后2.33±1.43和术后6个月1.08±0.95 (P < 0.01)。经皮椎体成形3 d后椎体高度恢复平均为前缘2.2 mm，中央3.2 mm。结果提示，经皮椎体成形注入聚甲基丙烯酸甲酯骨水泥是一种治疗非感染性椎体缺血坏死的有效方法，具有良好的止痛效果，并能部分恢复椎体高度。

Treatment of noninfected avascular necrosis of the vertebral body using polymethyl methacrylate bone cement with percutaneous vertebroplasty

Abstract BACKGROUND: Noninfected avascular necrosis of the vertebral body (NAVN) is not common, usually manifestated with compression fracture of vertebral body. There are few reports regarding it in China, due to insufficient understanding and low incidence. OBJECTIVE: To evaluate the characteristics of NAVN and the efficacy of percutaneous vertebroplasty (PVP) in the treatment of NAVN. METHODS: A retrospective clinical study on the effect of PVP in the treatment of 12 NAVN cases in recent five years was performed. Under the guidance of digital subtraction angiography, vertebral bodies were injected polymethyl methacrylate bone cement through the vertebral pedicle. The pain level of each patient was assessed, both before and after the procedure, using a visual analogue scale. The heights of anterior border and central vertebral bodies were measured before and after PVP in a lateral projection. RESULTS AND CONCLUSION: Twelve vertebral bodies of NAVN were successfully treated with PVP, and PMMA injected into each vertebral body was average (6.0±1.5) mL. Complete relief or obvious relief was obtained in 10 cases (83%), moderate relief was got in 2 cases (17%). Visual analogue scale score decreased from 9.08±0.76 before operation to 2.33±1.43 at 3 days after PVP, and 1.08±0.95 at 6 months after PVP (P < 0.01). The mean increase in vertebral body height at 3 days was 2.2 mm anteriorly and 2.3 mm centrally. PVP combined with polymethyl methacrylate injection is proved to be an effective procedure for the treatment of NAVN, it could provide quick pain relief and partially restore the height of compressed vertebral body.