经皮椎体成形术初步临床应用

目的：探讨经皮椎体成形术（percutaneous vertebroplasty，PVP）的临床应用价值。方法：应用PVP治疗21例37个椎体病变，其中骨质疏松性压缩骨折14例、转移瘤6例、血管瘤1例，胸椎病变17个、腰椎病变20个。PVP采取经皮经椎弓根或经皮经椎体后外侧入路穿刺病变椎体，将针尖置于椎体前1／3处，进行椎体骨内静脉造影，最后注入骨水泥2～10mL。术后观察PVP的操作成功率、治疗效果及并发症。结果：18例31个椎体PVP治疗成功，按病例数成功率为85．7％（18／21），按椎体数成功率为83．8％（31／37）。术后疼痛10例完全缓解（CR），5例部分缓解（PR），2例轻微缓解（MR），1例无效（NR），总有效率为94．4％（17／18）；无原椎体再发塌陷。有3例出现短暂的神经受累症状，经治疗后好转；余并发症症状轻微，无需处理。结论：PVP是一种有效、微创的椎体良恶性病变的治疗方法。

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OBJECTIVE: To investigate the clinical application of percutaneous vertebroplasty (PVP). METHODS: PVP was performed in 21 cases of 37 vertebral lesions,including 14 osteoporotic compression fractures, 6 metastases, 1 hemangioma,and 17 lesions in thoracic vertebra and 20 in lumbar. The procedures of PVP were as follows: The needle was inserted via percutaneous transpedicular approach or percutaneous posterolateral vertebral approach; the needle tip was placed at the junction of the anterior located the one third of the vertebral body; intraosseous venography was performed; and last bone cement was injected at 2-10 mL. The technical success rate, clinical efficacy and complications were observed after the procedure. Results The procedure was successful in 18 cases with 31 lesions,and the success rate according to the number of cases and vertebral lesions was 85.7% (18/21) and 83.8% (31/37), respectively. After the procedure, the numbers of complete remission, partial remission, mild remission and no remission were 10, 5, 2 and 1, respectively; and the total effective rate was 94.4% (17/18). Progressive compression did not occur. Three patients had transient neuropathy and recovered after physiotherapy. Other complications were insignificant; no severe complications occurred. Conclusion PVP is an effective and micro-traumatic treatment for patients with benign and malignant lesions in vertebral bodies.