骨质疏松性椎体压缩骨折患者经皮椎体成形注入黏丝期骨水泥后的再骨折

背景：目前经皮椎体成形术已成为治疗骨质疏松性椎体压缩骨折的首选方法,但其骨水泥注入后邻近椎体骨折并发症也在逐年增加,椎体成形过程中常采用黏丝期骨水泥注射,而骨水泥注射时状态可影响其在椎体内分布。 目的：回顾性分析骨质疏松性椎体压缩骨折经皮椎体成形注入黏丝期骨水泥后再骨折的原因。 方法：2006-07/2009-11对112例骨质疏松性椎体压缩骨折行经皮椎体成形术,术中DSA机透视引导下经单侧或双侧椎弓根入路,调配聚甲基丙烯酸甲酯骨水泥至黏丝期后经工作通道注入,并观察疗效。 结果与结论：每个椎体注入骨水泥2.4~6.0 mL,平均(3.40±1.02) mL。术中骨水泥渗漏至椎旁14例,椎间隙内15例。患者术后全部得到随访,随访时间6~15个月,平均(9.61±2.82)个月,未发现特殊的材料和宿主反应,29例患者疼痛再发,其中15例经MRI证实手术相邻椎体发生新鲜骨折,再次给予经皮椎体成形手术后疼痛症状缓解。结果提示经皮椎体成形注入黏丝期的骨水泥后应力集中、术中灌注剂渗漏椎间隙等综合因素增加了术后相邻椎体再次发生骨折的危险,寻找理想的骨水泥替代物将成为今后临床研究的方向。 关键词：骨水泥;骨质疏松性椎体压缩骨折;骨质疏松;经皮椎体成形术;生物材料 doi:10.3969/j.issn.1673-8225.2010.25.024     

经皮椎体成形术治疗椎体恶性肿瘤(附23例报告)

目的探讨经皮椎体成形术治疗椎体恶性肿瘤引起的剧烈疼痛的有效性。方法椎体恶性肿瘤患者共23例,肺癌椎体转移11例,乳腺癌椎体转移5例,骨髓瘤2例,原发性淋巴瘤2例,膀胱癌椎体转移1例,不明来源的恶性椎体肿瘤2例。诊断根据平片、CT、MR和ECT。入院时所有患者均有背部疼痛症状,6点疼痛评分为4.18±0.51分,运动能力评分4.83±0.39分。采用椎弓根入路,以配套活检针抽取组织学标本,配置1.3~1.8g/ml的骨水泥,将骨水泥缓慢注射到椎体中,使骨水泥在椎体病灶内分布、铸形。结果23例33节椎体成形术都获得成功,每节椎体注射骨水泥0.5~7ml。术后2d评估疗效9例患者术后疼痛完全缓解,10例明显缓解,2例中度改善,2例改善不明显。平均疼痛评分降为0.81±0.67,平均运动功能评分1.72±0.41。配对t检验术前、术后比较,有统计学意义(P<0.01)。结论采用经皮椎体成形术治疗椎体恶性肿瘤是一种创伤小、安全、有效的治疗手段,可以明显提高晚期恶性椎体肿瘤患者的生存质量。     

经皮椎体成形术治疗伴裂缝的椎体压缩性骨折

目的探讨应用经皮椎体成形术治疗伴裂缝的椎体压缩性骨折的技术及疗效,并总结分析压缩骨折中裂缝产生的原因及治疗方法。方法16例伴裂缝的椎体压缩性骨折患者术前均行X线平片、CT检查。X线平片或透视下可见裂缝的5例(组1),其中3例为仅在注射骨水泥时发现新出现的裂缝;术前仅CT可见裂缝的11例(组2)。所有患者均行6点疼痛评分及运动能力评分。组1中患者的平均疼痛评分为(4.45±0.47)分,运动能力评分(4.66±0.43)分;组2中患者的平均疼痛评分为(4.07±0.52)分,运动能力评分为(4.45±0.49)分。16例患者中6例有明确的外伤史,5例有轻微的外伤史,余5例没有明确的外伤史。所有患者均行活检,病理报告均为变性或坏死的骨组织。结果16例手术都获得成功,注射骨水泥3～7ml,14例疼痛完全缓解,2例明显缓解。术后2d重新进行疼痛及运动能力评分,组1的平均疼痛评分为(0.41±0.57)分,运动功能评分为(1.43±0.45)分;组2的平均疼痛评分为(0.47±0.41)分,运动功能评分为(1.56±0.39)分;配对t检验术前、术后有明显差异(P<0.01)。全部病例中共有2例骨水泥渗漏到椎间盘,没有骨水泥渗漏到椎体周围组织。术后随访1～9个月,无复发迹象,影像学检查提示骨水泥和椎体稳定。结论伴裂缝的椎体压缩性骨折是经皮椎体成形术的明确的适应证。椎体压缩性骨折一旦发现裂缝,尽早行经皮椎体成形术治疗可取得良好的疗效。     

经皮椎体后凸成形术治疗严重骨质疏松性椎体压缩性骨折

目的 探讨经皮椎体后凸成形术治疗严重骨质疏松性椎体压缩性骨折的疗效。方法 2014年1月至2015年1月应用经皮椎体后凸成形术治疗严重骨质疏松性椎体压缩性骨折42例,分析手术前后Cobb's角、疼痛视觉模拟量表（VAS）评分、Oswestry功能障碍指数及骨折椎体高度变化。结果 术后椎体三柱高度显著大于术前（P<0.05）,而术后Cobb's角、VAS评分、Oswestry功能障碍指数均显著低于术前（P<0.05）。结论 经皮椎体后凸成形术治疗严重骨质疏松性椎体压缩性骨折,可以明显改善患者疼痛症状,恢复椎体高度,矫正后凸角度,有着较好的疗效。     

多椎体病变一次性经皮穿刺注入骨水泥椎体成形31例

背景：老年性骨质疏松、骨髓瘤和转移性肿瘤时往往发生多个椎体的病变和压缩,但文献对多发性椎体病变的成型治疗报道较少。 目的：探讨多椎体胸腰椎病变一次性经皮穿刺注入骨水泥椎体成形的治疗效果和相关材料与宿主反应的注意事项。 设计、时间及地点：观察性试验,病例来自2004-11/2008-10十堰市太和医院脊柱外科、康复科和肿瘤科等。 对象：选择十堰市太和医院脊柱外科、康复科、肿瘤科等收治的老年性骨质疏松合并压缩性骨折、多发性骨髓瘤和溶骨性转移性肿瘤患者31例,男14例,女17例;年龄56~82岁。 方法：对31例2个以上椎体异常的患者进行一次性经皮穿刺椎体成形术。局麻下先后采用椎弓根入路穿刺病变椎体,在严密监测下依次向各病变椎体内加压注射骨水泥,术后观察椎体内骨水泥注入情况和患者的反应,术后1周评价治疗效果。 主要观察指标：一次性椎体成形的数目,椎体穿刺成功率,骨水泥注射量、椎体内骨水泥分布情况,骨水泥向椎旁软组织和静脉泄漏情况,疼痛缓解及有无并发症发生。 结果：共进行33次75个椎体的成型治疗,最少1次2个椎体,最多1次5个椎体,平均1次进行2.27个椎体成型;各椎体内骨水泥注射剂量4~12 mL,平均7.5 mL,椎体内骨水泥均匀充填49个,部分充填椎体者26个;注入骨水泥中未发生明显并发症,所有患者术后局部疼痛缓解,其中明显缓解或消失者20例,部分缓解者11例。 结论：经皮穿刺注入骨水泥椎体成形是治疗椎体病变有效而安全的方法,多椎体一次性成形治疗要求合理的骨水泥注射方法和剂量以及严密的治疗过程中的监测。     

椎体成形穿刺注射骨水泥防止灾难性并发症：87例137个椎体资料分析

背景：椎体成形治疗老年骨质疏松椎体压缩性骨折效果确切,但一些热点问题仍无定论。 目的：探讨椎体成形技术治疗老年骨质疏松椎体压缩性骨折过程中穿刺损伤、骨水泥注射剂量、多椎体成形及骨水泥渗漏等问题的解决方案。 方法：回顾性分析经皮穿刺椎体成形技术治疗骨质疏松椎体压缩性骨折87例137个椎体。全部经单侧椎弓根穿刺,骨水泥稀薄期注射,骨水泥注射量为3~7.5 mL,胸椎3 mL以上,腰椎4.5 mL以上,平均4.8 mL,多椎体者均一次手术完成。 结果与结论：随访6~30个月,治疗后第2天和最终随访时患者目测类比疼痛评分及Oswestry功能障碍指数评分均显著低于治疗前(P < 0.01)。所有患者胸腰背疼痛明显缓解,其中58例疼痛完全消失;1例术中出现骨水泥单体中毒症状,28例出现不同程度骨水泥渗漏,但未出现临床症状。137个椎体中骨水泥渗透达到和超过中线119个,占87.2%。提示椎体成形技术是治疗老年骨质疏松椎体压缩性骨折的有效方法。骨水泥稀薄期注射能够获得良好的渗透效果;在局麻药限量范围内,一次可完成3个以上椎体成形;严格正规的操作技术是预防骨水泥渗漏灾难性并发症最重要的方法。     

球囊扩张椎体后凸成形注入骨水泥治疗骨质疏松性脊柱骨折58例

背景：探讨球囊扩张椎体后凸成形注入骨水泥治疗骨质疏松性脊柱骨折的疗效。 方法：采用球囊扩张椎体后凸成形治疗老年人骨质疏松性单节段椎体压缩性骨折58例,58个椎体。病变位于T6~L4椎体,以T10~L2胸腰段发生多见。所有患者均采用局麻方法,患者俯卧于脊柱外科手术架上,在C臂透视下行单侧或双侧椎弓根穿刺,注入骨水泥。 结果：发生骨水泥渗漏8例,骨水泥沿后纵韧带渗漏至邻近椎体后缘1例,椎体外边缘6例,皮下1例,但患者没有临床症状。治疗后脊柱 X射线片显示椎体高度有所恢复,脊柱后凸畸形改善。所有患者疼痛明显缓解,疼痛缓解率100%,视觉模拟评分、后凸角度、活动能力评分治疗前与治疗后6个月比较,差异有显著性意义(P < 0. 05),治疗后6个月与随访结束时比较差异无显著性意义(P > 0. 05)。 结论：球囊扩张椎体后凸成形注入骨水泥治疗能够明显缓解骨质疏松性脊柱骨折导致的疼痛,并可以部分恢复椎体高度和脊柱后凸畸形,有利于改善脊柱的功能,提高患者的生活质量。 关键词：球囊扩张椎体后凸成形术;骨质疏松;胸腰椎骨折 doi:10.3969/j.issn.1673-8225.2009.47.040     

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。     

单侧椎弓根外入路椎体后凸成形术治疗胸椎骨质疏松性椎体压缩骨折38例

目的:评价单侧椎弓根外入路经皮椎体后凸成形术（PKP）治疗胸椎骨质疏松性椎体压缩骨折(OVCFs)的临床效果。方法:2004年7月～2008年5月采用行单侧经椎弓根外穿刺入路PKP治疗胸椎骨质疏松性VCFs患者38例;年龄55-72岁,平均60.3岁。结合体检、MRI及X线片确定责任椎体,骨折部位为T4-T12。手术前后进行视觉模拟评分（VAS）以及X线片测定,观察患者疼痛、病椎高度的恢复以及后凸畸形的矫正情况。结果：38例患者均安全完成手术,平均骨水泥注入量为3.2±1.4ml,随访6-24个月,平均9.5个月。术后背痛明显缓解,36例（95%）VAS评分获明显改善;椎体中线高度矫正率为50.9%,冠状位X线未发现椎体侧方楔形变增加。有3例共5个椎体出现骨水泥渗漏,但均未出现临床症状。结论：经椎弓根外入路单侧椎体后凸成形术是治疗胸椎骨质疏松性VCFs安全有效的方法,可有效恢复椎体高度、迅速缓解疼痛,提高患者生活质量。     

球囊扩张椎体后凸成形术治疗椎体压缩性骨折

随着人口的老龄化,骨质疏松症的发生率日渐增加。椎体压缩性骨折是骨质疏松症的主要并发症之一,由此引起难以忍受的背痛病例也呈上升趋势。服用药物、佩戴支具等姑息治疗效果不确切,且长期卧床会导致骨质进一步丢失,形成恶性循环;传统外科手术治疗创伤大,老年患者往往难以接受。1984年Galibert首先采用X线透视下,经皮穿刺椎体内注射骨水泥治疗侵袭性血管瘤取得满意效果。1994年Reiley在此基础上设计了通过球囊扩张来纠正后凸畸形的技术,     

Percutaneous vertebroplasty: technique and results in 192 procedures

Percutaneous vertebroplasty with acrylic cement (usually polymethylmethacrylate) consists of injecting cement into vertebral bodies weakened by osseous lesions. The objective of this procedure is to obtain an analgesic effect by mechanical stabilization in destructive lesions of the spine. The three major indications are aggressive vertebral hemangiomas, severe or refractory pain related to osteoporotic vertebral fractures, and malignant vertebral tumors. Complications are infrequent, but occur essentially in patients with vertebral malignant tumors. We present our experience with 148 patients that underwent 192 percutaneous PMMA vertebroplasties for the treatment of painful osteoporotic compression fractures (76 patients, 105 vertebral levels), hemangiomas (31 patients, 43 vertebral levels) and neoplasms (31 patients, 43 vertebral levels). In a vast majority of appropriately selected cases and especially in osteoporotic cases, vertebroplasty constitutes a relatively simple procedure with a very high rate of success.     

Percutaneous vertebroplasty: technique and early results in 25 procedures

Vertebroplasty procedure which involves percutaneous injection of bone cement into a collapsed vertebra using fluoroscopic guidance, has been introduced not only for treatment of osteoporotic patients, who have prolonged long lasting pain following vertebral fracture, but also for osteolytic vertebral compression fractures, to restore its loadbearing capacity and stiffness. Our result suggest that vertebroplasty is associated with pain relief in almost 100% of cases. Proper patient selection and a good technique should minimize complications.     

单侧穿刺经皮椎体注入骨水泥后凸成形治疗多椎体骨质疏松性压缩骨折

背景：经皮椎体成形和经皮椎体后凸成形是一种治疗骨质疏松症所致椎体压缩性骨折的新方法,目前已经在各大医院广泛开展,但是在临床上很多病例有多个椎体的骨折,采用经典的手术方法操作次数多,增加手术风险,射线暴露量大,医疗费用高。 目的：观察单侧穿刺经皮椎体后凸成形治疗老年多椎体骨质疏松压缩骨折的疗效。 方法：选择2007-06/2009-06巢湖市第一人民医院骨二科和皖南医学院附属弋矶山医院骨一科收治的多椎体骨质疏松压缩骨折患者12例(29椎),根据治疗前MRI信号改变判断疼痛性椎体并进行选择性单侧穿刺球囊扩张后凸成形的治疗。根据目测类比评分评价手术前后疼痛变化,观察治疗后症状改善、骨折复位情况及有无并发症发生。 结果与结论：12例穿刺均顺利完成,48 h内疼痛缓解,平均随访14个月。治疗后目测类比评分较治疗前降低(P < 0.01)。椎体前缘、中部、后缘平均高度治疗前低于治疗后,至末次随访椎体复位后前缘、中部、后缘平均高度未见明显丢失(P > 0.05)。治疗前穿刺侧与对侧椎体高度差距有显著性意义(P < 0.01),治疗后两侧差距无显著性意义(P > 0.05)。治疗前后同侧相比差异均有显著性意义(P < 0.01)。提示对多椎体压缩骨折采用选择性单侧穿刺后凸成形治疗,临床效果满意,能够缩短治疗时间、减少并发症、射线暴露和治疗费用,适于老年多椎体骨质疏松压缩骨折的治疗。 关键词：骨质疏松;脊柱;压缩骨折;后凸成形;骨水泥 doi:10.3969/j.issn.1673-8225.2010.25.025     

Vertebroplasty for pain relief and spinal stabilization in multiple myeloma

Mechanical stabilization of oncological vertebral fractures with cement augmentation is the first mechanism of pain relief, with or without restoration of vertebral body height. The aim of this study was to assess the safety and efficacy of vertebroplasty for painful vertebral body fractures in patients with multiple myeloma, in each phase of the disease. The authors reviewed a consecutive group of patients with multiple myeloma who underwent vertebroplasty at our Institute between November 2003 and December 2005. Twenty-eight levels were performed on 11 patients during 14 treatment sessions. All patients suffered from intractable back pain, and presented various lesion types (with and without fractures of posterior wall, and with and without epidural disease). The preoperative median visual analog scale (VAS) score was 7. The median duration of symptoms was 1.1 months. Eight patients were ambulating with orthopaedic devices (57%) in the pre-treatment period. Improvement or complete pain relief was observed in all patients (immediately in 8 cases, and after 2 days in 6 cases). The median VAS pain score decreased to 2. There was no symptomatic procedure-related complication. There were three cases (21%) of PMMA leakage: in the disc space in one case (7%), and in the anterior spinal canal in two cases (14%). Complete removal of orthopaedic devices was obtained in five patients (36%). No new deformation or collapse of the treated vertebrae was observed during the follow-up (range 1 day–25 months). In conclusion, vertebroplasty is a safe and efficient procedure in the treatment of painful vertebral body fractures in patients with multiple myeloma, without potential contraindications, such as fractures of the posterior wall or epidural disease. We also treated three and more levels in 28% of cases in a single session without complications. Due to the early pain relief and the low complication rate, it is possible to expand the indication to vertebroplasty for the prophylactic augmentation of those vertebral bodies at risk of fracture in which significant neoplastic substitution of the body is present.     

椎体成形术在椎体肿瘤治疗中的应用（附19例分析）

目的 探讨椎体成形术在椎体肿瘤治疗中的应用效果。方法 回顾性分析2012年6月至2015年8月应用椎体成形术治疗的19例椎体肿瘤的临床资料。结果 共成形29个椎体。经皮手术14例（24个椎体）,有6例（6个椎体）发生渗漏;术后3 d,11例疼痛明显缓解,2例改善不明显,1例加重。开放式脊柱手术中联合应用5例（5个椎体）,均效果良好。结论 椎体成形术是治疗椎体肿瘤的创伤小、安全、有效的治疗手段。     

Percutaneous vertebral surgery. Indications, technics and possibilities

The authors report their own experience with percutaneous vertebroplasty, one of the so called--minimally invasive methods, used to treat a certain group of spinal lesions affecting the vertebral bodies. The paper contains a brief review of the current literature, basic problems, indications and operative technique. The authors remark, that insertion of the needle into the vertebral body gives an access for biopsy before cement injection. This procedure was realised in the case of diagnostic uncertainty. Technical details of transpedicular biopsy are described. The authors present 2 representative cases. First case: a female with pathologic fracture of the Th7 vertebral body of osteoporotic origin. Treatment: combination of biopsy and vertebroplasty by percutaneous transpedicular approach. Second case: a female with cancer metastasis in L1 vertebral body, vertebroplasty was performed to support the anterior spinal column. Needle insertion was controlled either by radiofluoroscopy or by CT. The authors confirm pain relief related to vertebroplasty.     

Percutaneous vertebral augmentation: vertebroplasty and kyphoplasty: operative technique

The intravertebral injection of acrylic resin cement -usually polymethylmethacrylate (PMMA)- into a fractured vertebral body, constitutes the basis of the so called "vertebral augmentation techniques", "vertebroplasty" and "kyphoplasty", to manage pain and to strengthen and stabilize the compromised vertebra. In some ocassion, prior to the PMMA injection, an inflatable bone tamp was inserted into both pedicles of the fractured vertebra with the aim of restoring vertebral height to correct the kyphosis deformation. This procedure is called kyphoplasty (balloon-assisted vertebroplasty). The indications for vertebroplasty and kyphoplasty are evolving, from stabilization of painful osteoporotic vertebral fractures to vertebral collapse secondary to spinal metastases. In this paper we review the technical basis of both procedures, according to our experience in the treatment of vertebral fractures. Further studies are required to define the role for each technique in the spinal surgery's armamentarium.     

The Role of Bone Cement Augmentation in the Treatment of Chronic Symptomatic Osteoporotic Compression Fracture

Objective

Bone cement augmentation procedures such as percutaneous vertebroplasty and balloon kyphoplasty have been shown to be effective treatment for acute or subacute osteoporotic vertebral compression fractures. The purpose of this study was to determine the efficacy of bone cement augmentation procedures for long standing osteoporotic vertebral compression fracture with late vertebral collapse and persistent back pain.

Methods

Among 278 single level osteoporotic vertebral compression fractures that were treated by vertebral augmentation procedures at our institute, 18 consecutive patients were included in this study. Study inclusion was limited to initially, minimal compression fractures, but showing a poor prognosis due to late vertebral collapse, intravertebral vacuum clefts and continuous back pain despite conservative treatment for more than one year. The subjects included three men and 15 women. The mean age was 70.7 with a range from 64 to 85 years of age. After postural reduction for two days, bone cement augmentation procedures following intraoperative pressure reduction were performed. Imaging and clinical findings, including the level of the vertebra involved, vertebral height restoration, injected cement volume, local kyphosis, clinical outcome and complications were analyzed.

Results

The mean follow-up period after bone cement augmentation procedures was 14.3 months (range 12-27 months). The mean injected cement volume was 4.1 mL (range 2.4-5.9 mL). The unipedicular approach was possible in 15 patients. The mean pain score (visual analogue scale) prior to surgery was 7.1, which decreased to 3.1 at 7 days after the procedure. The pain relief was maintained at the final follow up. The kyphotic angle improved significantly from 21.2 ± 4.9° before surgery to 10.4 ± 3.8° after surgery. The fraction of vertebral height increased from 30% to 60% after bone cement augmentation, and the restored vertebral height was maintained at the final follow up. There were no serious complications related to cement leakage.

Conclusion

In the management of even long-standing osteoporotic vertebral compression fracture for over one year, bone cement augmentation procedures following postural reduction were considered safe and effective treatment in cases of non-healing evidence.     

Vertebroplasty in the treatment of spinal diseases

The results of surgical treatment by vertebroplasty are analyzed in 28 patients with different spinal diseases. A procedure for percutaneous vertebroplasty with polymethyl methacarylate is presented. This miniinvasive method has been shown to be highly effective in treating vertebral hemangiomas, osteoporotic compression fractures, and vertebral metastases and in strengthening the anterior vertebral column as compared with anterior spondylosis in open surgical operations.