CT引导下经皮局部持续异烟肼灌注冲洗联合臭氧吹注治疗脊柱结核脓肿的临床应用研究

目的 探讨CT引导下经皮病灶清除、局部持续异烟肼灌注冲洗联合臭氧吹注治疗脊柱结核脓肿的临床疗效.方法 69例脊柱结核并脓肿的患者均给予全身化疗并随机分为三组.21例患者进行CT引导下经皮穿刺病灶清除术,作为对照组.23例患者行CT引导下经皮穿刺病灶清除术,术后原结核病灶部位及脓肿部位放置灌注冲洗管进行灌注冲洗和持续局部异烟肼化疗,作为治疗A组.25例患者在CT引导下经皮病灶清除、局部持续异烟肼灌注冲洗的同时给予臭氧吹注治疗,作为治疗B组.治疗后CT复查,观察所有患者的脓肿吸收情况.结果 相同时间治疗后(90±20)天,对照组中脓肿完全吸收者1例,显效者3例,有效者7例,有效率约为52％,治疗A组中脓肿完全吸收者2例,显效者6例,有效者8例,有效率约为70％.治疗B组中,脓肿完全吸收者5例,显效者9例,有效者7例,有效率约为84％.三组的治疗有效率之间的差异具有统计学意义(P =0.001),治疗A组和B组的有效率均显著高于对照组(P =0.001),而治疗B组的有效率显著高于治疗A组(P =0.001).结论 CT引导下经皮病灶清除、局部持续异烟肼灌注冲洗联合臭氧吹注治疗脊柱结核脓肿疗效显著、痛苦小,无明显副作用,具有在临床上广泛应用的前景.     

CT引导下经皮穿刺微创介入治疗脊柱结核脓肿

目的评价CT引导下经皮穿刺置管冲洗引流治疗脊柱结核脓肿的作用及疗效。资料与方法搜集近2年临床诊断为胸、腰椎结核并椎旁脓肿形成且经平片或CT检查证实的患者资料11例。在CT定位下,取椎旁脓肿最大层面穿刺,经穿刺定位针并扩张达5．0mm工作套管,置入双腔同轴引流管,保留引流管并用药物冲洗引流,同时配合临床口服抗结核药物治疗。结果经3～24个月随访,10例取得良好的疗效（其中7例治愈,3例有效）,1例疗效不理想,所有病例均无并发症发生。结论CT引导下经皮穿刺置管冲洗引流化疗治疗脊柱结核是一种操作简便、安全有效、创伤很小的介入治疗方法。     

脊柱结核的CT诊断

目的探讨脊柱结核的CT表现及脊柱结核CT检查的重要意义。方法对30例临床和病理确诊的脊柱结核病例的CT表现进行回顾性分析。结果脊柱结核的CT表现包括:(1)椎体及附件不规则虫蚀样和囊状骨质破坏。(2)沙砾样和斑片样死骨形成。(3)椎间盘坏死及椎间隙狭窄、消失。(4)椎旁脓肿、纵隔脓肿、腰大肌脓肿。(5)椎体后部的骨质破坏产生的碎骨片和坏死物质可进入椎管压迫硬膜囊和神经根。(6)椎体塌陷呈楔形。结论CT对脊柱结核的诊断和鉴别诊断有重要价值,尤其脊柱结核对椎体附件和椎管的累及范围、程度可清楚地显示,对指导手术治疗和判断预后有重要意义。     

CT扫描对脊柱结核早期诊断的意义

目的:评价CT在脊柱结核早期诊断中的应用价值。材料与方法:10例早期脊柱结核患者,其中男性7例,女性3例,年龄为5～30岁,平均25岁,于发病后5个月至1年内经CT扫描后确诊。结果:CT扫描1、能清晰显示椎体的微小骨质破坏、死骨的大小与数目,以及死骨周围干酪样物的形成状况2、可清晰显示椎间盘的破坏程度、及相邻间盘及椎体软骨板的破坏状况,3、还可较早地发现双侧或单侧肿胀的腰大肌、腰小肌、髂腰肌及其脓肿等。CT确诊脊柱结核的中心型6例,边缘型3例,混合型1例。结论:CT可以显示X线上所不能显示的种种微小病变,它是脊柱结核早期诊断的重要工具。     

脊柱转移癌经皮椎体成形术联合125Ⅰ粒子植入治疗

经皮椎体成形术(percutaneous vertebroplasty,PVP)是在影像学技术(DSA机、X线或CT等)引导下应用特殊穿刺针经过皮肤穿刺到病变椎体,然后将骨水泥注入,加固病变椎体、恢复脊柱稳定性的一种介入新技术.笔者自2004年7月开展PVP联合125Ⅰ粒子植入椎体内治疗脊柱转移癌,发现局部抗肿瘤作用明显,现报道临床观察的初步结果.     

脊柱转移癌经皮椎体成形术联合125I粒子植入治疗

经皮椎体成形术（percutaneous vertebroplasty，PVP）是在影像学技术（DSA机、X线或CT等）引导下应用特殊穿刺针经过皮肤穿刺到病变椎体，然后将骨水泥注入，加固病变椎体、恢复脊柱稳定性的一种介入新技术。笔者自2004年7月开展PVP联合^151I粒子植入椎体内治疗脊柱转移癌，发现局部抗肿瘤作用明显，现报道临床观察的初步结果。     

单纯后路手术治疗下腰椎脊柱结核的临床效果分析

目的探讨单纯后路手术进行病灶清除、自体植骨或钛笼融合及椎弓根螺钉内固定术治疗成人下腰椎脊柱结核的方法和临床疗效。方法患者采用俯卧位,以病变椎体棘突为中心纵向切开,显露椎板、椎间关节和横突,从病变严重侧进入,探查清理破坏椎体,刮除干酪样坏死组织,清除死骨和破损的椎间盘。当椎体破坏不超过50%时在病椎上植入椎弓根螺钉,否则在邻近正常椎体上植入螺钉,在上下相邻正常椎体植入椎弓根螺钉时,咬除病灶椎体一侧椎板、关节突及椎弓根,吸净椎管内及椎体周围脓液,伴有椎管侵袭者进行椎管减压,注意观察椎管内硬膜的紧张程度,判断椎管压力的大小,以预判椎体撑开、加压的程度。先撑开病变节段以矫正后凸畸形,取自体髂骨或钛笼置于骨缺损处,用抗结核药物作术部冲洗,再在病灶内及钛笼周围植入链霉素粉剂2 g,放置引流后关闭切口。结果采用单纯后路手术进行病灶清除、自体植骨或钛笼融合及椎弓根螺钉固定术治疗成人下腰椎脊柱结核患者22例,术后均得到良好的脊柱稳定性和肢体运动功能的修复。手术时间平均为(4.5±1.2)h,术中出血量平均(820±65.1)ml,术中均无严重并发症,术后3~12周血沉均恢复正常,脊柱后凸畸形矫正率为(55.2±10.5)%,末次随访时,矫正角度丢失率为(60.8±11.2)%。术前22例脊髓功能损害患者末次随访时,14例Frankel分级改善1级,6例改善2级,2例改善3级。术后12个月随访时发现脊柱内固定无松动,植骨处均已骨性融合,术后继续抗结核治疗无复发。结论下腰椎脊柱结核合并有椎体前、中、后柱的三柱破坏时,采用前后路联合手术治疗最为经典,但为了减少术中体位的变换和操作步骤的繁琐,我们单纯采用后路手术,只要术中病灶清除的细致、彻底,脊髓减压充分,后凸畸形得到良好的矫正,同样可以取得良好的手术治疗效果。     

CT引导下经皮肝脓肿穿刺置管引流术的应用

目的观察CT引导下经皮肝脓肿穿刺置管引流治疗肝脓肿的疗效和临床应用价值。方法对临床诊断明确并经实验室及影像学检查证实的36例患者在CT引导下经皮肝脓肿穿刺引流,术中置管,术后定时冲洗并积极进行有效的抗生素治疗。结果 36例肝脓肿患者经皮穿刺置管引流术治疗后,临床症状消失,无并发症发生,经B型超声或CT复查脓肿消失,全部治愈出院。结论 CT引导下经皮肝脓肿穿刺置管引流术具有操作简便、手术创伤小、住院费用低、疗效肯定等优点,是临床治疗肝脓肿的有效方法之一。     

CT引导下经皮穿刺肝脓肿引流术的临床应用

目的：探讨CT引导下经皮穿刺肝脓肿引流术的临床应用。方法：对27例肝脓肿患者行CT引导下经皮穿刺引流术，通过CT扫描确定脓肿的位置、穿刺途径、角度及深度后，进行穿刺直接抽吸或置管引流，其中7例行穿刺直接抽吸脓液1—3次，20例行放置引流管持续引流。结果：27例行穿刺37次，穿刺成功率100％。穿刺路径包括腹前壁18例(25次)、侧壁4例(7次)、后壁5例(5次)。共放置引流管21根。随访13—46天，症状明显好转、病灶缩小或消失26例，治愈率96．3％(26／27)。1例引流15天后转入手术治疗。并发症：置管过程中脓肿破入腹腔1例，无其他严重并发症。结论：CT引导下经皮穿刺肝脓肿引流术，可大大缩短病程，创伤小，操作简单，只要掌握好适应症和技术要领，成功率、治愈率高，并发症少而轻，值得推广应用。     

脊柱结核CT诊断价值(附56例分析)

目的:探讨分析脊柱结核的CT表现及诊断价值。方法:利用螺旋CT对有脊柱结核的56例患者进行扫描。结果:56例有不同程度的骨质破坏、椎旁软组织肿胀、腰大肌脓肿,死骨形成,椎间盘破坏及椎管狭窄。结论:螺旋CT扫描图像清晰,分辨率高,能显示X线检查难以发现的骨质破坏,揭示病变范围及其对椎管的累及程度,有助于对病变的术前评价和术后分析。     

Percutaneous catheter drainage of tuberculous and nontuberculous psoas abscesses

Objective: To assess the utility of percutaneous catheter drainage in the management of tuberculous and nontuberculous psoas abscesses associated without any bony involvement or with minimal bony lesions that could not cause vertebral instability. Materials and method: Eleven patients with psoas, iliopsoas and pelvic abscesses were drained under computed tomography and ultrasono-graphy guidance. Results: There were 15 (10 tuberculous, 5 pyogenic) abscesses in 11 patients. Six of the tuberculous abscesses and one of the pyogenic abscess were associated with vertebral involvement. Vertebral lesions were located in one or two vertebrae without causing any serious disturbance in the vertebral stabilization. In one case, the abscess was bilateral. Nine cases were drained under computed tomography guidance, while two cases were drained under both computed tomography and ultrasonography guidance. One session drainage was sufficient for abscess resolution in uniloculated cases. In the two of four multiloculated cases, catheter drainage was performed twice. Relapse of the abscess was found in only one patient. The mean abscess volume was 520 ml and mean drainage duration was 12 days. None of the cases required surgery. Conclusion: Percutaneous drainage, chemotherapy and additional external brace application with the cases associated with bony lesion may be used for treatment of tuberculous and nontuberculous unilocule and multiloculated abscesses.     

CT引导下经皮穿刺肝脓肿的介入治疗

目的 探讨CT引导下穿刺抽吸、冲洗治疗肝脓肿的方法和价值。方法 在CT引导下经皮穿刺对35例肝脓肿进行抽吸及冲洗治疗，冲洗液采用庆大霉素与甲硝唑混合溶液。结果 本组35例肝脓肿中多房脓肿8例、单房脓肿27例；其中8例脓肿腔内见有气体。经过一次抽吸冲洗治愈者25例，二次治愈者4例，三次治愈者6例。抽吸冲洗出脓汁的量在35mL-760mL。绝大部分病人治疗后于当日体温恢复正常。5例未住院，其余30例病人住院时间平均6．5d。结论 CT引导下经皮穿刺治疗肝脓肿是一项操作简便安全、非常有效的治疗方法，这种方法具有定位准确、损伤小、适应性广泛、便于广泛推广的突出特点。     

CT引导经皮椎体成形术治疗椎体转移瘤

目的:回顾性评价CT引导下经皮椎体成形术治疗椎体转移瘤的疗效及其并发症。方法:2008-10～2010-10共治疗椎体转移瘤患者27例,共36个椎体。患者均有顽固性胸背痛,术前VAS评分平均9.1分,伴脊髓压迫者2例,术前Frankel分级C级3例,D级4例,均采用CT引导下经皮椎体穿刺行病变椎体内骨水泥注射治疗。随访观察并发症发生情况及治疗效果。结果:36个椎体在CT引导下均一次穿刺成功,术后疼痛缓解有效率为88.4%,完全缓解率27.9%,VAS评分术后(2.5±1.6)较术前(7.4±1.3)显著下降(P<0.05)。随访7～24个月,中位数10.8个月,末次随访时VAS评分2.98±0.81分,有效率78%,与术前比较差异有显著性(P<0.01);骨水泥外溢发生率为25%,无一例发生严重并发症。结论:CT引导下经皮椎体成形术具有良好的止痛及预防病理性骨折作用,改善患者生活质量,是治疗椎体转移性肿瘤安全、有效的方法。     

50例脊柱结核的CT及X线平片表现分析

选择５０例经ＣＴ诊断及手术病理证实的脊柱结核，对ＣＴ及Ｘ线平片表现进行回顾性分析，结果表明：ＣＴ发现椎体及附件骨破坏特别是较小较轻微的骨破坏及椎管内侵犯的能力、显示死骨及局限性脓肿的能力优于平片，能区别脓肿及肉芽肿。而Ｘ线平片显示椎间隙狭窄、脊柱滑脱等优于ＣＴ。结合文献讨论了与脊柱转移瘤的鉴别诊断。     

经皮椎体成形术治疗椎体骨髓瘤(6例分析)

目的:评价经皮椎体成形术(PVP)治疗多发性骨髓瘤椎体病变的临床疗效,探讨该技术能否作为多发性骨髓瘤椎体病变常规治疗手段。方法:回顾性分析6例多发性脊髓瘤患者共19个椎体(胸椎10个、腰椎9个)在DSA监视下行PVP术的术后疗效,其中5个椎体已发生压缩性骨折。采用视觉模拟评分方法(VAS)评价患者术前和术后的疼痛情况,并采用配对t检验对所得数据进行统计学分析。结果:所有患者手术均获成功,在术后第一天疼痛缓解不显著(P>0.05),术后一周疼痛缓解显著(P<0.05)。5个椎体发生椎旁渗漏,2个椎体发生下椎间盘渗漏,1个椎体发生硬膜外渗漏,但无明显临床症状。术后3个月所有患者平片复查均未见手术椎体发生压缩性骨折或进一步塌陷(术前已发生压缩性骨折的)。结论:经皮椎体成形术是治疗椎体骨髓瘤的有效方法,创伤小且安全可靠,可以考虑作为多发性骨髓瘤椎体病变的常规治疗手段。     

Splenic abscess: percutaneous drainage

Experience with percutaneous drainage in four cases of splenic abscess is presented. Percutaneous drainage and antibiotics were curative in three of four cases. The one case not adequately treated by antibiotics and percutaneous drainage was also complicated by ascites and multilocular collections. Percutaneous drainage in this case did not adversely affect subsequent curative surgery. Percutaneous catheter drainage of splenic abscess under radiologic guidance can be a safe, effective treatment.     

Percutaneous drainage of psoas abscess under real-time computed tomography fluoroscopic guidance

Objectives  The goal of our study was to determine the usefulness of percutaneous abscess drainage under guidance of computed tomography (CT) fluoroscopy. Materials and methods  Our subjects were 21 patients (seven women, 14 men; mean age 64 years; age range 30–87 years) who had undergone percutaneous drainage of 26 psoas abscess lesions under CT fluoroscopic guidance between May 2001 and January 2008. Drainage methods involved a needle puncture, insertion of a guidewire, serial dilations, and the exchange of the needle with a drainage tube. The procedures were guided by use of a helical CT scanner that provided real-time fluoroscopic reconstruction. Results  Percutaneous drainage under real-time CT fluoroscopic guidance was successfully performed in every procedure. Use of real-time CT fluoroscopy allowed rapid assessment of needle, guidewire, and catheter placement. No patient had serious complications related to the drainage procedure. The mean procedure time required to drain one lesion was 35.6 ± 13.6 min. Mean period after the drainage procedure until complete disappearance of the abscess as confirmed by CT was 12.4 ± 10.0 days (range 3–46 days). Conclusion  CT fluoroscopy is useful in achieving accurate and safe drainage of abnormal psoas fluid collections.     

Kyphoplasty: indications, contraindications and technique

PURPOSE: Percutaneous Kyphoplasty is an emerging Interventional Radiology technique consisting in injecting polymethylmethacrylate (PMMA) into collapsed vertebral bodies under fluoroscopic guidance, after compaction of the cancellous bone with two dedicated balloon catheters. The purpose of our study was to assess the indications, contraindications, technique and results of our initial study. MATERIALS AND METHODS: Between January and May 2003 we treated 11 patients (5 men, 6 women) with vertebral collapse occurred up to three months earlier and due to osteoporosis or myeloma (mean age: 68.9), with pain refractory to medical therapy. All patients underwent treatment on a single vertebra (1 D7; 1 D8; 2 D12; 3 L1; 3 L2; 1 L4). Patient selection was based on clinical and instrumental criteria: conventional radiography, CT and MR were performed on all patients before the procedure. The Visual Analogue Scale (VAS) for pain assessment was used to evaluate the post-procedure results. RESULTS: All patients showed an increase in the height of the collapsed vertebral body, associated with partial or complete pain relief (VAS score decreasing from a pre-treatment score of 8 to a score of 2 after treatment). No complications related to the procedure were recorded. CONCLUSIONS: The indications for kyphoplasty include recent vertebral compression fractures due to osteoporosis, myeloma, metastasis and vertebral angioma with intractable pain and with no neurological symptoms. The main contraindications are coagulation disorders, unstable fractures or complete vertebral collapse (vertebra plana). Kyphoplasty proved to be a safe and effective method for the treatment of intractable pain due to vertebral collapse that allows for shorter hospital stays and an immediate improvement in the patient's quality of life.     

脊柱结核与脊柱转移瘤的多排螺旋CT鉴别诊断

目的分析脊柱转移瘤和脊柱结核的CT表现,探讨二者的CT鉴别诊断。方法回顾性分析我院2005～2011年经手术、病理及临床证实的脊柱结核与转移瘤40例,观察椎体、附件骨、椎间盘破坏方式,椎旁、椎管内脓肿的范围及脊髓受压情况,分析两组患者的CT影像学表现。结果 26例脊柱结核CT表现为骨质破坏、高密度死骨形成、椎体压缩、椎间盘破坏、椎旁、腰大肌脓肿、或椎管狭窄等症状;14例脊柱转移瘤征象是椎骨骨质破坏、增生或两者并存;以溶骨性破坏多见,常伴有椎旁软组织肿块形成,椎体引起压缩。结论多层螺旋CT能对脊柱转移瘤和脊柱结核的诊断及鉴别诊断提供帮助。