经皮椎体成形术的临床应用

目的:探讨经皮椎体成形术的穿刺方法及治疗椎体转移性肿瘤和老年性压缩性骨折的临床疗效.材料和方法:对106例患者共141个椎体在DSA监视下行椎体成形术,其中椎体转移性肿瘤83例,老年性压缩性骨折23例.结果:106例手术全部成功,疼痛完全缓解98例,部分缓解8例.胸椎注入骨水泥为2～4ml,平均3.1ml、腰椎注入3～8ml,平均4.85ml,骶椎4ml.141个椎体中骨水泥外漏发生率为14.9%,其中出现椎间盘漏8个椎体、硬膜外漏9个椎体、椎旁静脉丛2个椎体、椎旁软组织2个椎体,但均未出现临床症状.结论:经皮椎体成型术对缓解或消除由椎体病变引起的疼痛有明显的治疗效果.无神经症状的骨水泥外漏可不视为并发症.     

椎体成形术的临床应用

目的探讨经皮椎体成形术的穿刺方法及治疗椎体转移性肿瘤和老年性压缩性骨折的临床疗效。方法对81例患者(男47，女34，年龄35～84，平均61．2岁)共110个椎体行椎体成形术，其中椎体转移性肿瘤61例，老年性压缩性骨折20例，在DSA监视下进行。结果81例手术全部成功，疼痛完全缓解78例，部分缓解3例。胸椎注入骨水泥为2～4ml，平均3．1ml、腰椎注入3～8ml，平均4.85ml，骶椎4ml。81例中出现椎问盘漏6例、硬膜外漏8例、椎旁静脉丛2例、椎旁软组织2例，但均未出现临床症状。结论经皮椎体成型术对缓解或消除由椎体病变引起的疼痛有明显的治疗效果。无神经症状的骨水泥外漏可不视为并发症。     

经皮椎体成形术治疗上胸椎转移瘤的应用

目的 评价经皮椎体成形术(PVP)治疗上胸椎转移瘤的疗效.方法 回顾分析20例(31个椎体)T1～T4水平的转移性肿瘤的PVP资料.其中9个T1椎体、7个T2椎体、8个T3椎体和7个T4椎体.采用视觉模拟评分(VAS)评价患者术前、术后3 d和1个月的疼痛程度.分析上胸椎PVP穿刺技术、骨水泥注射量和术后并发症.结果 所有患者手术均获成功.骨水泥分别在T1、T2、T3和T4椎体注入1.7～2.8 ml、1.8～3.2 ml、1.7～3.1 ml和1.6～3.1 ml,平均(2.4±0.8)ml.术后疼痛缓解率为100%.术前VAS为7.2±2.0,术后3 d VAS为2.5±2.3(P<0.01).术后1个月VAS为2.2±2.3,与术前比较差异有统计学意义(P<0.01).13个椎体出现骨水泥外渗,包括5个椎旁渗漏,3个静脉渗漏,3个椎旁软组织渗漏,2个硬膜外渗漏.除1例出现轻微并发症,其他未发生严重临床症状的并发症.结论 PVP治疗上胸椎转移瘤安全、有效.     

经皮椎体成形术治疗椎体肿瘤引起的椎体压缩性骨折

目的 探讨经皮椎体成形术(PVP)治疗椎体肿瘤引起的椎体压缩性骨折的方法及其效果。资料与方法 对11例13个椎体行PVP，其中椎体转移瘤9例(11个椎体)，血管瘤l例，骨髓瘤1例；颈椎1例，胸椎5例，腰椎4例，骶椎1例。年龄37—72岁，平均60．5岁。在C型臂X线机监视下，用10～13G骨穿针经椎弓根刺人椎体后，用外科锤将骨穿针钉人椎体，并注入欧乃派克1ml，观察有无粗大的引流静脉显影，然后注入按3：2：1配制的聚甲基丙烯酸甲酯(PMNA，骨水泥)2～5ml.结果 11例13个椎体1次穿刺成功12个，2次穿刺成功1个。2例骨水泥渗入椎旁软组织内，1例经椎体静脉引流导致肺栓塞。结论 PVP治疗椎体转移瘤、血管瘤、骨髓瘤引起的椎体压缩性骨折安全可行，止痛效果好，提高了肿瘤患者的生活质量。     

经皮椎体成形术治疗椎体转移性肿瘤的疗效分析

目的 探讨经皮椎体成形术(PVP)治疗椎体转移性肿瘤的疗效及其影响因素.方法 入住南京东南大学附属中大医院椎体转移性肿瘤患者163例266节椎体采用PVP治疗且随访资料完整,原发癌肿主要为肺癌(42例),肝癌(19例),食管及胃肠癌(34例),肾癌(10例),乳腺癌(46例)等.PVP术后3 d CT复查观察骨水泥分布状况及有无渗漏.按PVP术后24 h,1周,1、3、6和1年以上定期随访评价临床疗效、疼痛复发的原因及观察生存时间.结果 266节椎体PVP操作均成功,138节胸椎骨水泥平均注入量为(3.6±1.5)ml,128节腰椎为(4.5±1.7)ml.平均随访时间(12.0±10.6)个月,术后24 h,1周,1、3、6和12个月有效率分别为87.7%(143/163)、92.6%(151/163)、91.4%(149/163)、84.5%(136/161)、78.3%(108/138)和77.2%(71/92).术后12个月症状复发39例,复发率23.9%(39/163),包括骨水泥周围癌肿进展6例,其他椎体转移33例.平均生存时间(10.5±10.5)个月,其中乳腺癌与前列腺癌椎体转移54例生存时间为(15.4±11.7)个月,明显长于肺癌、肝癌、胃肠癌及肾癌等105例的生存时间[(8.5±8.1)个月](P<0.05).随访期间死亡136例,主要死亡原因为脊椎外原发肿瘤进展及全身多发转移衰竭.CT证实椎旁骨水泥渗漏58例,均无临床症状.结论 PVP治疗椎体转移性肿瘤可迅速缓解疼痛且可保持较长时间稳定;疼痛复发的主要原因是其他椎体新发转移;生存时间与椎体外原发癌肿类型和合并内脏转移密切相关.     

椎体骨质疏松性骨折两种椎体成形术的疗效比较

 目的 比较经皮椎体成形术(percutaneous vertebroplasty,PVP)和经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗老年骨质疏松椎体压缩性骨折的疗效。方法 选取2017-01至2019-12医院收治的因骨质疏松椎体骨折行PVP或PKP治疗的老年患者共112例(132椎),根据选择术式的不同分为PVP组和PKP组,其中PVP组伤椎68个,PKP组伤椎64个。记录两种不同术式手术前后 VAS 评分、伤椎椎体增加高度、骨水泥注入量、手术时间、骨水泥渗漏情况。结果 PVP 组和PKP组术前和术后1 d的VAS评分比较,差异无统计学意义。PKP组术后修复伤椎高度为(11.5±3.2)mm,明显高于PVP组的(2.1±1.3)mm,差异有统计学意义(P<0.05)。PKP组骨水泥注入量也明显多于PVP组,两组比较差异有统计学意义(P<0.05)。PVP 组术中骨水泥渗漏 23个椎体(33.8%),PKP 组渗漏12个椎体(18.8%),PVP 组并发症高于PKP 组。结论 两种手术方式均能达到很好的止痛效果。但PKP恢复椎体高度上优于PVP,骨水泥注入量多,渗漏率低,临床治疗更有优势。     

经皮椎体成形术中骨水泥剂量对骨质疏松椎体力学性能的影响

目的探讨经皮椎体成形术(PVP)中注入骨水泥的剂量与各节段骨质疏松椎体强度和刚度恢复之间的关系。方法 54个骨质疏松椎体(T8～L4)取自6具女性尸体,脊柱不同节段的椎体分别被随机分成三个组:2、4和6ml骨水泥组。所有椎体标本被制成压缩性骨折,测定原始强度和刚度;经单侧椎弓根分别注射骨水泥2、4或6ml后再次进行压缩实验,测定强化后椎体的强度和刚度。结果 2ml骨水泥能使胸椎椎体强度增加,而腰椎及胸腰段椎体需要4ml。而对于刚度,2ml骨水泥可使胸椎和胸腰段椎体刚度增加,4ml骨水泥才能使腰椎椎体刚度增加。结论 2ml骨水泥即可使胸椎及胸腰段椎体强度和刚度恢复或增加,而腰椎椎体则需要4ml骨水泥,不同节段的椎体骨水泥用量不同,这些数据可为临床PVP中注射骨水泥剂量提供参考。     

经皮椎体成形术的临床应用

目的　探讨经皮椎体成形术 (PVP)治疗椎体病变引起的压缩骨折的技术操作和临床效果。资料与方法　对 30例共 4 6个椎体行PVP ,其中骨质疏松 2 0例 ,血管瘤 1例 ,多发性骨髓瘤 1例 ,转移瘤 8例。年龄 31～ 98岁 ,平均 5 8岁。穿刺方法为患者俯卧 ,影像增强器向矢状面足侧成角 10°～ 15° ,椎体上下缘没有双边影 ,使欲穿刺侧的椎弓根投影在椎体的中外 1/ 3处 ,将穿刺针、X线管、椎弓根成一直线进针 ,穿刺成功后将聚甲基丙烯酸甲酯 (PM MA ,骨水泥 )按粉液比 3∶2 (g/ml)混合成糊状 ,在透视下用 1ml注射器均匀缓慢注入病变椎体。如骨水泥弥散不良再行对侧穿刺。术后当天、7天、1个月、3个月CT检查注射椎体 ,随访病情变化。结果　所有病例均成功施行了PVP ,单侧穿刺 32个椎体 (胸椎 8个 ,腰椎 2 4个 ) ,双侧穿刺 14个椎体 (胸椎 8个 ,腰椎 6个 )。单侧穿刺胸椎骨水泥平均用量 2 .5ml,腰椎 3.7ml;双侧穿刺胸椎骨水泥平均用量 3.2ml,腰椎 4 .7ml。治疗效果同骨水泥的注射量无关 ,同单双侧穿刺无关。 2 1例良性病例疼痛完全缓解 (CR) 14例 ,部分缓解 (PR) 7例 ;9例恶性病例中PR 7例 ,2例无效(NR) ;随访 6个月良性病例止痛效果良好 ,恶性病例 3个月后止痛效果下降。CT、X线随访骨水泥术后形态无变化 ,未见椎体     

高黏度骨水泥治疗骨质疏松性椎体压缩骨折的疗效观察

目的 观察高黏度骨水泥经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩骨折的临床疗效.方法 选择骨质疏松性椎体压缩骨折患者80例随机分为两组,每组40例,均行PVP手术治疗,研究组给予高黏度骨水泥,对照组给予低黏度骨水泥,术后3d内CT复查观察椎体内骨水泥分布和椎旁渗漏情况.用疼痛视觉模拟评分(VAS)和日常生活活动能力评分(Barthel)评价两组疗效.比较两组骨水泥注入量、渗漏情况、手术费用和术中X线曝光时间.结果 80例患者PVP操作均成功,术前、术后24h、术后第7天VAS和Barthel评分两组间比较差异均无统计学意义(P＞0.05),同组患者PVP前后比较差异则有统计学意义(P＜0.05).骨水泥平均注入量:研究组4.60 ml,对照组4.41 ml(P＞0.05);X线曝光时间:研究组4.17 min,对照组3.93 min (P＞0.05);骨水泥渗漏:研究组4节段,对照组12节段(P＜0.05);手术费用:研究组26 132元/节段,对照组925 1.5元/节段(P＜0.01),研究组平均多耗费16 881元/节段.结论 采用高黏度和低黏度骨水泥治疗骨质疏松性椎体压缩骨折都能迅速减轻患者腰背部疼痛,提高日常生活活动能力.高黏度骨水泥可减少渗漏,但价格偏高.     

经皮椎体成形术后影像学评价

目的 探讨影像学检查在经皮椎体成形术(PVP)后诊断的应用价值.资料与方法 回顾分析85例因骨质疏松性压缩骨折行PVP患者的临床和影像学资料,所有患者术后均行X线和CT检查,25例术后再发疼痛的患者行MRI检查.结果 40个椎体发生骨水泥渗漏,26个椎体出现椎旁静脉渗漏,10个椎体出现椎旁软组织渗漏,10个椎体出现椎管内渗漏,5个椎体出现椎间盘渗漏,2个椎体出现椎间孔渗漏,2个椎体出现穿刺针道渗漏.新发骨折12例共15个椎体,6个椎体骨折发生在相邻椎体,9个发生在不相邻椎体.结论 CT应作为PVP后观察骨水泥渗漏必要的影像学检查方法,MRI在诊断新发骨折方面具有优势.     

经皮椎体成形术在椎体压缩骨折及椎体血管瘤治疗中的应用

目的:总结经皮椎体成形术治疗疼痛性椎体压缩性骨折和疼痛性椎体血管瘤的临床经验,评估其治疗疗效。方法:回顾性分析26例疼痛性椎体压缩性骨折和3例疼痛性椎体血管瘤的椎体成形术治疗病例。病椎39个,其中胸椎18个,腰椎21个,36个采用单侧椎弓根入路,3个采用双侧椎弓根入路。结果:29例治疗均获得成功,注射骨水泥2.5~5.0ml,平均3.2ml。术后随访6~12个月,完全缓解(CR)、部分缓解(PR)、轻微缓解(MR)和无效(NR)例数分别为24、3、2、0,疼痛缓解率93.1%。患者的视觉模拟评分(VAS)术后显著下降(P0.05)。结论:采用经皮椎体成形术治疗疼痛性椎体压缩性骨折及疼痛性椎体血管瘤是一种微创、安全、有效的治疗手段。     

Kyphosis correction and height restoration effects of percutaneous vertebroplasty

BACKGROUND AND PURPOSE: Percutaneous vertebroplasty is known for its pain-relieving effect. Our purpose was to evaluate its effect on the kyphosis angle, wedge angle, and height of the fractured vertebral body. METHODS: We reviewed digital radiographs of 73 vertebral bodies in 53 patients before and after vertebroplasty. We measured the spinal kyphosis angle and the wedge angle of the fractured vertebral body. Ratios of the height of the anterior border, center, and posterior borders of the collapsed vertebra to the height at the posterior border of an adjacent normal vertebral body were measured. Gain from vertebroplasty and the restoration percentage (gain divided by loss) were calculated for each parameter. RESULTS:The kyphosis angle, wedge angle, anterior height, center height, and posterior height significantly improved after vertebroplasty. The mean reduction in the kyphosis angle was 4.3 degrees, and the wedge-angle reduction was 7.4 degrees. The mean wedge-angle reduction in fractured vertebral bodies containing gas was 10.2 degrees. Restoration percentages for the kyphosis angle and wedge angle were 19% and 44%, respectively. Gain in the height of the fractured vertebral bodies was 16.7% for the anterior border, 14% for the center, and 7% for the posterior border. Restoration percentages for the height of the vertebral body were 29% for the anterior border and 27% for the center. CONCLUSION: Vertebroplasty increases the height of the fractured vertebra and reduces the wedge and kyphosis angles. These effects are most remarkable in fractured vertebra containing gas.     

Percutaneous vertebroplasty: indications, contraindications, technique, and complications

Percutaneous vertebroplasty is emerging as one of the most promising new interventional procedures for relieving (or reducing) painful vertebra, with the injection of surgical polymethylmethacrylate or cement into vertebral bodies. This imaged-guided technique, originally used to treat vertebral hemangioma, has recently been extended to the treatment of metastases, osteoporotic compression fractures, and vertebral myeloma. It is increasingly being accepted as a main treatment of choice in the management of resistant back pain due to vertebral compression fractures, especially in the elderly individual who is not a candidate for surgery. In this article, we review indications, contraindications, technique, and complications of percutaneous vertebroplasty.     

经皮椎体成形术在椎体肿瘤治疗中的临床应用

目的:探讨经皮椎体成形术(PVP)治疗椎体肿瘤性病变的临床效果.方法:应用PVP治疗32例44个椎体良恶性肿瘤病变.在C型臂X光机透视导向下经皮穿刺到病变椎体后注入骨水泥.记录患者术前、术后24 h、术后1周、术后1个月的疼痛视觉模拟划线得分(VAS),观察止痛效果和并发症.结果:44个椎体皆一次穿刺成功,穿刺成功率100%.一月后疼痛缓解程度为:完全缓解(CR)者8例,部分缓解(PR)者21例,轻度缓解(MR)者2例,无效(NR)者1例,总有效率(CR PR)为90.6%(29/32).患者术前与术后24 h、术后1周、术后1个月的VAS得分差异有显著性意义(P<0.05).PVP术后8个椎体发生无症状的骨水泥渗漏无1例椎体塌陷加重或发生新的骨折,无1例发生严重并发症.结论:PVP治疗椎体肿瘤性病变成功率高,效果良好.     

Percutaneous Vertebroplasty for Osteoporotic Compression Fracture: Multivariate Study of Predictors of New Vertebral Body Fracture

Purpose To investigate the risk factors and relative risk of new compression fractures following vertebroplasty. Methods Initially, we enrolled 104 consecutive patients with vertebral compression fractures caused by osteoporosis. A total of 83 of the 104 patients visited our hospital for follow-up examinations for more than 4 weeks after vertebroplasty. Logistic regression analysis of the data obtained from these 83 patients was used to determine relative risks of recurrent compression fractures, using 13 different factors. Results We identified 59 new fractures in 30 of the 83 patients: 41 new fractures in vertebrae adjacent to treated vertebrae; and 18 new fractures in vertebrae not adjacent to treated vertebrae. New fractures occurred in vertebrae adjacent to treated vertebrae significantly more frequently than in vertebrae not adjacent to treated vertebrae. Only cement leakage into the disk was a significant predictor of new vertebral body fracture after vertebroplasty (odds ratio = 4.633). None of the following covariates were associated with increased risk of new fracture: age, gender, bone mineral density, the number of vertebroplasty procedures, the number of vertebrae treated per procedure, the cumulative number of vertebrae treated, the presence of a single untreated vertebra between treated vertebrae, the presence of multiple untreated vertebrae between treated vertebrae, the amount of bone cement injected per procedure, the cumulative amount of bone cement injected, cement leakage into the soft tissue around the vertebra, and cement leakage into the vein.     

C形臂X线机与CT联合导向在经皮椎体成形术中的应用

目的探讨在移动式C形臂X线机与16排CT联合导向下,经皮椎体成形术中在治疗骨质疏松性椎体压缩骨折的操作方法及优势。方法将移动式C形臂X线机与16排CT置于同一机房,组成组合机。16排CT扫描病变椎体及相邻椎体,确定穿刺点及穿刺路径,评价术后椎体情况;移动式C形臂X线机实时透视监视注射聚乙烯吡咯烷酮(骨水泥)。结果在组合机引导下对12例单椎体压缩骨折的患者行经皮椎体成形术成功率100%,无并发症发生。结论移动式C形臂X线机与16排CT联合导向在经皮椎体成形术中的操作简便、定位准确、监视实时、导向安全,特别提高了L4椎体平面以上各椎体行椎体成形术的安全性。     

Effect on partial pressure of oxygen in arterial blood in percutaneous vertebroplasty

BACKGROUND AND PURPOSE: The purpose of this study is to estimate the change in partial pressure of oxygen (Pao(2)) during percutaneous vertebroplasty and also to examine the factors related to the change in Pao(2). MATERIALS AND METHODS: We retrospectively reviewed preprocedural and postprocedural Pao(2) of 59 consecutive patients who underwent percutaneous vertebroplasty between November 2003 and April 2005 (11 men and 48 women; age range, 50-93; mean age, 75 years). Fifty-four patients were treated for osteoporosis-related fractures and 5 had malignant disease. Percutaneous vertebroplasty was performed in a conventional manner under local anesthetics and conscious sedation. Preprocedural and postprocedural blood drawing was performed 5 days to 30 minutes before percutaneous vertebroplasty and also at 30 minutes after the injection of bone cement. The difference between preprocedural and postprocedural data of Pao(2) was correlated with patients' age, number of treated vertebral bodies, presence of cement leakage, and presence of malignant neoplasm for each patient. RESULTS: Mean pre-Pao(2) and post-Pao(2) were 80.9 +/- 1.4 and 70.6 +/- 1.3 mm Hg (mean +/- SE) respectively (P = .0001). Using analysis of variance, there was a significant difference according to the number of vertebral bodies. There was a positive trend of decrease in Pao(2) according to the number of vertebral bodies during percutaneous vertebroplasty. Using multiple linear regression and after adjusting by preprocedural Pao(2) and other variables, the number of vertebral bodies was still highly significant. CONCLUSION: Pao(2) decreases during percutaneous vertebroplasty, and there is a correlation between the number of treated vertebral bodies and decrease in Pao(2).     

3.0T MR IDEAL-IQ序列对成年女性腰椎脂肪含量测量及临床价值

目的:采用IDEAL-IQ序列对不同年龄成年女性腰椎椎体脂肪含量进行定量分析,间接反映其骨质强度。方法:选取60例健康女性及15例发生腰椎压缩性骨折的成年女性,对每位受试者行腰椎MRI常规序列及IDEAL-IQ序列扫描,在GE后处理工作台上测量其椎体的脂肪分数。结果:对不同年龄组腰椎椎体平均脂肪分数(fatfraction,FF)值及同一年龄组不同椎体的FF值均采用单因素方差分析,结果均具有统计学差异(P值均小于0.05)。随着受试者年龄的增加,腰椎椎体内骨髓脂肪含量逐渐增加,椎体脂肪分数与年龄呈明显的相关性(r=0.82,P<0.05),不同椎体的脂肪分数变化程度也不一样,脂肪分数越高其骨质强度越低。结论:3.0T磁共振IDEAL-IQ序列不失为测量椎体内脂肪含量的快速、可靠的方法,并可早期发现女性椎体骨质强度的变化。     

Percutaneous Vertebroplasty

Percutaneous vertebroplasty (PVP) with acrylic cement [polymethylmethacrylate (PMMA)]consists of injecting PMMA into vertebral bodies weakened by osseous lesions. The aim of PVP with PMMA is to obtain an antalgic effect by consolidation in destructive lesions of the spine. There are three major indications: vertebral angiomas, osteoporotic vertebral crush syndromes, and malignant vertebral tumors. Indications in vertebral angiomas only concern patients with aggressive clinical signs (severe pain or nervous compression) and/or aggressive radiological signs. Indications in osteoporotic vertebral crush syndromes only concern patients suffering from back pain related to one or two adjacent vertebral collapses resistant to medical treatment for several weeks. Indications in malignant vertebral tumors only concern patients suffering from severe back pain related to a destruction of the vertebral body, not involving the major part of the cortical bone. Complications of PVP occur essentially in patients with vertebral metastasis. In the great majority of cases, these complications heal under medical treatment. In patients with osteoporotic vertebral crush syndromes or vertebral angiomas, the complications are represented by the increase or onset of radiculalgias (in less than 1%), which disappear after local anesthetic injection.     

骨质疏松压缩骨折经皮椎体成形术后影像学评价

目的:从影像学角度对我院采用经皮椎体成形术(PVP)结合术中过伸体位治疗新鲜老年骨质疏松性椎体压缩骨折(OVCF)的临床疗效进行评价。方法:收集近3年来我院应用PVP治疗OVCF患者37例(共39个椎体),分别对其术前、术后及术后半年随访时的侧位X线片进行测量,计算出其椎体压缩率及cobb’s角,对所得数据进行统计学分析,从影像学角度对疗效进行评价。结果:本组患者均得到了半年以上的随访,术前、术后椎体压缩率及cobb’s角比较均有显著性差异,术后椎体压缩率及cobb’s角与半年后随访比较无显著性差异。结论:在严格掌握适应证和严格手术操作的前提下,采用PVP结合术中过伸体位治疗新鲜的OVCF,可以在一定程度上有效恢复压缩椎体的高度,纠正脊柱的后凸畸形,并能有效维持椎体高度,防止椎体进一步塌陷,影像学评价满意。