椎体成形术治疗合并囊腔样变的骨质疏松性椎体压缩骨折

目的　研究经皮椎体成形术(PVP)治疗合并椎骨内囊腔样变的椎体压缩骨折关键技术、近期疗效及对椎体高度的恢复。方法　回顾分析4年来PVP治疗2 0 7例骨质疏松症并32 6节椎体压缩骨折,其中2 7例共32节椎体压缩为合并椎骨内囊腔样变。PVP操作均在透视监视下经椎弓根行椎体穿刺,所有椎体均用非离子造影剂行椎体造影。术后1dCT观察聚甲基丙烯酸甲酯(PMMA)分布状况和有无渗漏,测量PVP前后椎体高度,观察临床疗效和有无并发症。结果　PVP技术成功率1 0 0 %。椎体造影主要表现为造影剂注入压缩骨折椎体内后呈囊状分布并滞留。PMMA平均注入量为6 .8ml。CR、PR和NR分别为6 6 .7%、1 8.5 %、1 4 .8%,总有效率为85 .2 %。椎体前缘高度恢复2～1 5mm ,平均5 .38mm ,中央高度恢复3～1 6mm ,平均6 .4 1mm ,前缘和中央高度恢复有统计学意义(P <0 .0 5 ) ;后缘高度恢复0～1mm ,平均0 .0 6mm ,两者差异无显著性(P >0 .0 5 )。CT证实椎体前侧旁PMMA渗漏3例,但无1例出现临床症状。结论　PVP治疗椎体内合并囊腔样变的压缩骨折的疗效显著,可明显恢复压缩椎体高度,且发生PMMA渗漏的可能性更小。提高疗效的关键是抽去椎体内囊腔积液和尽可能多地充填PMMA ;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。

Percutaneous vertebroplasty for osteoporotic vertebral compression fractures with intraosseous cystic cavitary phenomena

Objective To evaluate the key technique, short term clinical efficacy and degree of changes in vertebral body height for percutaneous vertebroplasty in treating patients with osteoporotic vertebral compression fractures containing intraosseous cystic cavitary phenomena. Methods Thirty two vertebrae of painful compression fractures with intraosseous vacuum sign occurring in 27 patients were identified from 326 percutaneous vertebroplasties perforfmed in 207 patients during 4 years. PVP was performed under C-arm fluoroscopy guidance only with local anesthesia. Intraosseous venography was performed on each vertebra by hand injection with non-ionic contrast agent, with CT monitoring after PMMA injection for the PMMA distribution in the vertebrae and looking for leakage. The heights of 32 vertebral bodies were measured before and after the vertebroplasty. The efficacy of PVP was evaluated during the follow-up. Results The successful rate of PVP was 100%. Main appearance of vertebral venography showed cystic cavity-like, stasis of contrast medium within the marrow space of the fractured vertebra. 6.8 ml of PMMA in average was injected into each vertebra. CR, PR and NR were obtained respectively 66.7%, 18.5%, 14.8% during 1 month-4 years of follow-up. The average increase in vertebral body height was 5.38 mm anteriorly, 6.41 mm centrally and 0.06 mm posteriorly. The heights restoration of vertebrae anteriorly and centrally were significantly different(P<0.05), but the heights restoration of vertebrae posteriorly showed no significant different (P>0.05). No serious complications related to the technique occurred, except 3 cases with asymptomatic PMMA leakage around vertebrae demonstrated by CT. Conclusions Significant pain relief and vertebral height restoration by PVP in the treatment of patients with painful vertebral compression fractures accompanied by intraosseous cystic cavitary change ,are promising with low-rate of PMMA leakage. The basic successful mechanism lies on the proper complete PMMA filling predicting through venogrophy.