经皮椎体成形术中骨水泥注射量与疗效和并发症的相关性研究

目的 探讨经皮椎体成形术(PVP)在治疗骨质疏松性椎体压缩骨折中骨水泥注射量与疗效的关系,以及骨水泥渗漏的预防.方法 2002年1月至2007年2月,应用PVP治疗骨质疏松性椎体压缩骨折121例,共163个椎体,其中胸椎101个,腰椎62个.患者在C型臂X线机临测或者CT定位下行PVP治疗.将骨水泥的注射量与椎体病变体积的比例分为4级:1级充填比例<25%,2级填允比例25%～50%,3级填充比例51%～75%,4级填充比例>75%,术后行X线片及CT检查并分析骨水泥在椎体的分布,评价骨水泥的渗漏、疼痛缓解情况及脊柱的稳定性.疼痛缓解采用WHO标准进行评估.结果 121例患者骨水泥注射量平均为(4.2±0.8)mL.骨水泥填允比例具体分布为1级64个,2级72个,3级27个椎体,胸椎注射1～2 mL 18个,腰椎注射2～3 mL 11个椎体.1、2、3级椎体骨水泥渗漏率分别为18.8%、29.2%和48.1%.121例患者术后获6～24个月(平均9.8个月)随访,患者背部疼痛均有不同程度缓解或者消失.填充比例为1级、2级、3级各组之间的疼痛缓解差异无统计学意义(χ2=0.059,P>0.05).填允比例为2、3级患者椎体前、中、后缘高度及Cobb角在于术前后差异有统计学意义(P<0.05),而1级患者差异无统计学意义(P>0.05).结论 PVP在治疗骨质疏松性椎体压缩骨折中,骨水泥的注入量与临床效果之间无必然联系,从治疗的安全性考虑,手术时应适当限量注射骨水泥(胸椎1～2 mL,腰椎2～3 mL),且应使骨水泥分布均匀.

Effect of bone cement injection volume on the therapeutic results in percutaneous vertebroplasty

Objective To investigate the effect of bone cement injection volume on the therapeutic results in percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture in the elderly patients.Methods From January 2002 to February 2007, 121 old patients with osteoporotic vertebral compression fractures in 163 vertebral bodies were treated by PVP monitored by C-arm fluoroscopy, CT or CT plus C-ann fluoroscopy.They were examined by fluorography and CT after operation to analyze the distribution of bone cement in the vertebral bodies.The capacities of bone cement injected were divided into 4 levels according to the proportions between the volume of bone cement and pathological volume of the vertebral body.Postoprerative X-ray and CT scan were andueted to detect the distribution of bone cement in the vetebrae.Evaluation of the pain relief was done according to the WHO criteria.Results All the cases were fol-lowed up for 6 to 24 (average, 9.8) months.Back pain was effectively relieved after operation in all cases.Pain relief was not significantly different among patients with 1, 2 and 3 levels of injection capacity (P > 0.05) .The risks of leaking increased with the levels of injection capacity.Conclusions The curative effect of PVP may be fine for osteoporotic vertebral fractures.The key point in preventing the main compli-cation, leakage of bone cement, is to accomplish the injection in a well-suited volume.