胸腰椎压缩性骨折的经皮穿刺椎体成形术治疗

目的:探讨经皮穿刺椎体成形术的常规手术方法和对不同胸腰椎椎体疾病的临床治疗效果。方法:对64例共76个椎体的胸、腰椎椎体病变患者进行71次经皮穿刺椎体成形术(PVP)和5次经皮穿刺椎体后凸成形术(PKP),X线下椎弓根入路穿刺进入椎体行骨髓腔造影并向椎体内加压注射聚甲基丙烯酸甲酯骨水泥。结果:椎弓根穿刺成功率100%,骨水泥均匀充填椎体者45例次,部分充填椎体者31例,成形术后椎体前部高度部分恢复者37例,74例患者手术后局部疼痛不同程度缓解,缓解起效时间在注射骨水泥后15min至3d.结论:经皮穿刺椎体成形术和经皮穿刺脊柱后凸成形术是治疗椎体压缩性骨折和椎体肿瘤的有效而安全的方法,尤其适用于年龄大、机体状况差和不能接受大型手术的高危患者。

The Treatment of Vertebral Compression Fracture by Percutaneous Vertebroplasty

Objective To evaluate the clinical value and the routine operation methods of percutneous vertebroplasty in treatment of various pathological changes of vertebral body.Methods 71 cases with percutaneous vertebroplasty(PVP) and 5 cases with percutaneous kyphoplasty(PKP) were performed in 64 patients with symptomatic osteoporotic vertebral compression fractures (76 vertebal bodies). The puncture catheter was inserted into the vertebral body through the vertebral pedicle and vertebral veingraphy was performed immediately, then the bone cement (polymethylmethacrylate,PMMA) was filled vertebral body. Results Puncturing through vertebral pedicle was successful in all patients. Aortography demonstrated that the vertebral marrow was filled well. PMMA evenly filled in vertebral body in 45cases, part of vertebral body filled in 31 cases. After PVP and PKP procedures, the anterior height of the corpus vertebral body restore 37 cases. Satisfactory results were obtained in 88% of cases postoperation 15 minute to 3 days.Conclusion PVP is a very safe and effective method to treat vertebral compression fractures, especially to the old and weak patients who cannot tolerate surgical operation.