椎体后凸成形术治疗椎体压缩性骨折中穿刺活检的价值

目的评价椎体压缩性骨折患者行椎体后凸成形术（PKP）时,穿刺活检测定未预料的恶性肿瘤的发生率。方法回顾性分析我院PKP术中穿刺所得的活检样本,2003年1月至2010年7月行PKP治疗椎体压缩性骨折患者216例,男60例,女156例,年龄36～92岁,平均68.4岁。其中有恶性疾病病史者9例,术中共取活检标本249个,由资深病理科医师对标本进行评价。结合患者病史、术前术后症状、病理结果及影像学资料综合分析。结果所有患者压缩性骨折获得治愈,疼痛缓解,症状消失,未出现有症状的并发症。204例病理结果符合压缩性骨折的诊断,表明了骨折愈合的不同阶段。9例有恶性疾病病史患者中,6例确诊为转移性肿瘤,3例活检时未发现恶性病变。另3例患者之前未诊断为恶性疾病病理结果显示恶性。结论 PKP术中常规取活检并不会增加手术风险,但能证实潜在的压缩性骨折的病理过程。本研究中未预料到的恶性肿瘤发生率为1.4%,我们推荐在PKP治疗椎体压缩性骨折中常规取病理活检。

Diagnostic value of biopsy during kyphoplasty for presumed osteoporotic vertebral compression fractures

Objective To evaluate the incidence of unsuspected malignancy in bone biopsies of patients undergoing PKP for presumed osteoporotic vertebral compression fractures（OVCFs）.Methods From January 2003 to July 2010, 216 patients underwent vertebral body biopsies in conjunction with kyphoplasty for vertebral compression fractures.Average patient age was 68.4（range,36 - 92）,including 60 males and 156 females,9 of them had a history of malignancy.249 biopsies were obtained from all the patients.Histologic/immunohistochemical evaluations were performed by experienced pathologists.A definitive diagnosis was obtained from comprehensive analysis clinic data including patient history,preoperative and postoperative symptoms,pathological findings and radiologic films.Results All patients treated in this study healed their VCFs following surgery and no clinical complications were experience as a result of the kyphoplasty and all patient charts were available for review.The biopsy results of 204 patients were consistent with the presumed diagnosis of OVCFs.9 patients who had a history of malignancy were confirmed on the pathological examination and 3 patients were not confirmed.Pathologic results of 3 patients with previous diagnosis as malignant disease showed malignant.Conclusion Obtaining bone biopsies during PKP does not lead to increased morbidity and can verify the pathologic process underlying the vertebral compression fractures.Since this study showed an unsuspected malignancy rate of 1.4%,we advocate obtaining a vertebral body biopsy prior to every vertebral augmentation procedure.