多椎体压缩骨折的经皮穿刺椎体成形术治疗

目的 :探讨多椎体压缩骨折行经皮穿刺椎体成形术的方法、疗效及手术注意事项。方法 :采用单纯C型臂X线机监视引导 ,俯卧位或侧卧位 ,多椎体同时穿刺注射方法进行手术。本组 7例 (2 5个椎体 )年龄 6 0～ 79岁 ,男 2例 ,女 5例。每例患者骨折椎体数 3～ 9个 ,PVP手术椎体数 3～ 6个 ,骨折压缩程度 2 5 %～ 80 %。手术前及术后 2天和术后 4月时分别进行活动能力、止痛药使用情况及疼痛强度视觉类比评分 (VAS)。结果 :俯卧位手术 2例 ,侧卧位手术 5例 ,手术时间 2 .0～ 4 .5h ,单侧注射 16个椎体 ,双侧注射 9个椎体 ,单椎体骨水泥注射量 0 .5～ 4 .0ml。 7例止痛药使用评分 ,术后比术前降低 (T =0 ,P<0 .0 1) ,4例术后完全不用止痛药 ,随访时仍保持该水平。活动能力评分在术后 2天比术前增加 (T =0 ,P <0 .0 1) ,术后 4月进一步改善。疼痛强度VAS在术后 2天时比术前下降 2 .1～ 6 .4 ,平均 5 .1,自身前后比较有极显著性差异 (t=7.4 ,P <0 .0 0 0 5 ) ,随访时仍维持术后水平。结论 :多椎体压缩骨折采用PVP治疗有效 ,单纯透视引导下侧卧位多椎体同时穿刺注射是较好方法。

Multiple-level vertebral body compression fractures treated with percutaneous vertebroplasty

Objective:To evaluate the effectiveness and procedure of C-arm fluoroscopy-guide percutaneous vertebroplasty(PVP) for the treatment of multiple level vertebral body compression fractures.Methods:Seven cases(5women and 2 men) suffering from multiple level vertebral body compression fractures( range 3-9 levels), underwent 3 to 6 levels' PVP guided by a single plane C-arm fluoroscopy in prone position or lateral recumbent position.The age of cases was from 60 to 79.Visual analgesic scale(VAS), analgesic use and mobility were measured in each patient at pre-PVP, 2 days post-PVP and 4 months post-PVP.Results:PVP procedures were successful in prone position of 2 cases and in lateral recumbent position of 5 cases.The time consumed by PVP in each patient was from 2.0 to 4.5 hours. Unipedicular approach was used in 16 fractured vertebrae and bipedicular approach in 9 fractured ones.The volume of polymethylmethacrylate(PMMA) injected into each vertebral body was from 0.5 ml to 4.0 ml.In all 7 cases, the procedure increased mobility and decreased analgesic use ( T=0,P <0.01).VAS was decreased for a mean of 5.1(range 2.1-6.4)from pre-PVP to 2 days post-PVP( t=7.4,P <0.0005),and maintained almost the level at 4 months post-PVP.Conclusion:Multiple-level vertebral body compression fractures could be treated with PVP effectively,and the useful method to perform PVP for those patients is to treat multiple levels in one time,in lateral recumbent position and by C-arm fluoroscopic guidance.