经皮穿刺椎体成形术治疗合并肺气肿的胸椎压缩性骨折

目的 探讨合并严重肺气肿的胸椎压缩性骨折进行经皮穿刺椎体成形术的技术特点和治疗效果。方法 7例(10个椎体)合并严重肺气肿并且透视椎体显示不清的胸椎骨质疏松椎体压缩骨折患，侧卧位在CT结合C型臂透视引导下进行经皮穿刺椎体成形术。术前、术后2d和随访时分别测定疼痛强度评分、止痛药使用和活动能力评分。随访2-8个月，平均5个月。结果 7例皆顺利完成手术，注射骨水泥的量平均2．2ml／椎体(1．0～4．0m1)，无临床并发症，手术时间2—3．5h／例。疼痛强度评分值术后2d比术前平均减低3．9，随访时进一步下降0．2—2．9，活动能力和止痛药使用术后均明显改善。结论 合并肺气肿的胸椎压缩性骨折患行经皮穿刺椎体成形术治疗前应进行骨折椎体透视检查，显示不清选择侧卧位在CT结合C型臂透视引导下穿刺注射可获得良好疗效。

Percutaneous vertebroplasty in thoracic-vertebral-compression-fracture patients with pulmonary emphysema

Objective To evaluate the effectiveness and technical procedure of percutaneous vertebroplasty (PVP) used to treat the thoracic vertebral compression fracture patients with pulmonary emphysema. Methods Seven cases (10 vertebral body) suffering from osteoporotic thoracic vertebral body compression fractures, combined with pulmonary emphysema, underwent PVP guided by a combination of CT and C arm fluoroscopy because of their unclear view during preoperative fluoroscopic examination. Under CT guidance, 11G or 13G bone biopsy needle was placed to the target point of the fractured vertebral body. Then, polymethylmethacrylate (PMMA) mixed with barium sulfate was injected into the vertebral body visualized in real time by the operator with the aid of constantly lateral fluoroscopy. The procedure was performed in lateral recumbent position. The mean age of cases was 66(from 54 to 77). Vasal analogic scale(VAS),analgesic use and mobility were measured in each patient at pre PVP, 2 days post PVP and mean 5 months'(from 2 to 8 months) follow up. Results PVP procedures were successful in all 7cases. The time consumed by PVP in each patient ranged from 2.0 to 3.5 hours. The volume of polymethylmethacrylate (PMMA) injected into each vertebral body was from 1.0 ml to 4.0 ml(mean 2.2ml). Small leaks were observed by CT scan after operation in a treated vertebra, without clinical sequelae. VAS decreased on average 3.9 (ranging from 2.4 to 6.0) from pre PVP to 2 days post PVP (P< 0.001), and maintained the almost same level at the follow up. The procedure decreased need for pain medication and increased mobility. Conclusion It is necessary for the thoracic vertebral compression fracture patients with pulmonary emphysema to check the fractured vertebrae with fluoroscopy before PVP. Those who couldn't be visualized clearly in fluoroscopic view can be treated effectively with PVP guided by a combination of CT and C arm in lateral recumbent position.