CT引导下经皮椎体成形术治疗椎体良恶性病变的技术探讨

目的：探讨CT引导下经皮穿刺椎体成形术治疗脊柱病变时技术的优化和并发症的防治.方法：对45例共62个椎体行经皮穿刺椎体成形术,其中血管瘤4例4个椎体、骨质疏松7例12个椎体、椎体恶性肿瘤34例46个椎体.经CT扫描定位,将不透X线骨水泥（主要成分为粉剂甲基丙烯酸树脂多聚体和液态甲基丙烯酸树脂单体）按粉剂与液体为4∶1比例混合调制成糊状,用1ml注射器匀速缓慢注入病变椎体.结果：本组完全缓解率（CR）77.78%,部分缓解率（PR）17.78%,有效率为95.56%.止痛作用2周至18个月持续有效.CT和平片随访观察骨水泥密度、形态与术后所见无变化,未见椎体进一步压缩.术后即刻CT证实有7例10椎骨水泥向椎体周边组织渗漏,只有1例硬膜外渗漏者导致暂时性神经根性痛.结论：经皮穿刺椎体成形术适用于椎体血管瘤、骨质疏松、转移瘤等溶骨性病变,只要我们操作得当,可以避免多数并发症的发生.

The application of CT-guided percutaneous vertebroplasty in spinal benign and malignant diseases

Objective:To investigate the clinical applications of percutaneous vertebroplasty(PVP) for spinal stabilization and pain relief.Methods:Forty-five patients underwent 62 PVP including 4 vertebral hemangiomas with 4 PVP, 7 osteoporosis with 12 PVP, and 34 vertebral malignant tumors with 46 PVP. PVP was done with radiopaque bone cement under the CT guidance. The ratio of powdery polymethyl methacrylate to liquid metyl methacrylate was 4:1. The ropy paste was mixed and slowly injected using 1ml syringe.Results:The analgesic effectiveness was 95.56%.The rate of CR is 77.78% and the rate of PR is 17.78%. The analgesic time began from PVP and lasted from 2 weeks to 18 months. The density and form of bone cement were unchanged on follow-up imaging. No further compression of vertebral body occurred. There are 7 cases with paravertebral cement leaks and only 1 case with nerve root irritation.Conclusion:The indications of PVP are the vertebral hemangioma, vertebral osteoporosis, osteolytic metastases, and other osteolytic diseases. Most complications can avoid when performed by experienced physicians who exercise good judgment.