骨静脉造影在椎体成形术治疗症状性椎体血管瘤中的价值探讨

目的 评价经皮椎体成形术(PVP)治疗症状性椎体血管瘤的安全性、临床疗效,探讨术中先行椎体骨静脉造影是否能降低骨水泥(PMMA)渗漏的发生及提高临床疗效.方法 2001年3月至2010年1月,南京东南大学附属中大医院放射科治疗椎体血管瘤患者45例共53节,均有不同程度胸背部或腰背部疼痛,其中马尾受压瘫痪1例,椎体压缩骨折3例.分为两组:A组为先行椎体骨静脉造影后再注入PMMA共23例27节椎体;B组为直接注入PMMA 22例26节.PVP后1～3 dCT复查观察PMMA分布及有无椎体周围渗漏.比较两组疗效、PMMA渗漏情况、注入量、手术成本及术中X线辐射时间.结果 PVP技术成功率100%,PMMA平均注入量3.96 ml.随访6个月～5年,除A组初期1例无效外,余44例术后1周疼痛均有改善,术后1、3个月疼痛进一步减轻,6个月及1年疗效均保持稳定,CR、PR和NR分别为84.5%、13.3%、2.2%.6个月时,A组有效率为95.7%,B组为100%,两组比较差异无统计学意义(P=0.323).CT证实PMMA椎旁渗漏共有8节,均无临床症状,其中A组有6节,B组有2节(P=0.140).A组平均注入PMMA量为3.70 ml,B组为4.23 ml(P=0.157);A组平均手术费用为7.24千元/节,B组为5.84千元/节(P=0.000),B组比A组节省约1.4千元/节;A组平均X线照射时间为13.28 min,B组为8.78 min(P=0.000),B组比A组减少约4.5 min.结论 PVP为椎体血管瘤安全、有效的治疗方法;技术要领为经血管瘤侧椎弓根穿刺,PMMA应完全充填血管瘤并部分超出其边缘;椎体骨静脉造影不能提高PVP疗效和安全性,相反增加了手术成本和X线照射时间.

Value of intraosseous venography in percutaneous vertebroplasty for treatment of symptomatic vertebral hemangionas

Objective To evaluate the clinical efficacy of percutaneous vertebroplasty (PVP) in patients with symptomatic vertebral hemangiomas and determine whether prior intraosseous venography decreases extravertebral leakage of PMMA and improves clinical outcomes in these procedures.Methods Retrospective review was conducted on 45 consecutive patients with 53 symptomatic vertebral hemangiomas associated with chronic pain (all cases) or paralysis caused by spinal cord compression (1 case) or vertebral compression fractures (3 cases) treated with PVP at our institution to define two populations.Group A consisted of 27 vertebral hemangiomas in 23 patients who underwent intraosseous venography before injection polymethylmethacrylate (PMMA).Group B consisted of 26 vertebrae in 22 patients who underwent injection PMMA without prior venography.CT was done 1 to 3 days after PVP to observe PMMA distribution in vertebrae and whether leakage.Clinical outcomes,included pain relief,leakage of PMMA,volume of PMMA injected,expense and X-ray exposure times in each vertebral body,were compared in the two groups by using x2 or t test.Results No significant difference was seen between the groups with respect to age,sex,the number of treated vertebrae,or preprocedural degrees of pain.The successful rate of technique of PVP was 100%.The mean volume of PMMA injected in each vertebra was 3.96 ml.CR,PR and NR was obtained respectively 84.5%,13.3% and 2.2% during 6 months to 5 years of follow-up expect one case had unrelieved pain in group A.At 6 months after PVP,22 cases (95.7%) in group A and 22 cases (100%) in group B achieved adequate pain relief (P = 0.323).6 vertebrae (6/27) in group A and 2 vertebrae (2/26) in group B with asymptomatic leakage of PMMA were demonstrated by CT (P =0.140).The mean volume of PMMA injected in each vertebra was 3.70 ml in group A and 4.23 ml in group B (P =0.157).The mean expense of each vertebra was (￥)7.24 × 103 in group A and (￥)5.84 × 103 in group B (P=0.000),the mean decreases were (￥)1.4 × 103 in group B than group A.The mean X-ray exposure times on each vertebral body was 13.28 minutes in group A and 8.78 minutes in group B (P =0.000),the mean decreases were 4.5 minutes in group B than group A.Conclusions PVP is an effective and safe procedure for treating symptomatic vertebral hemangiomas.Prior intraosseous venography does not significantly improve the effectiveness or safety of PVP for vertebral hemangiomas performed by qualified,experienced operators,on the other hand,it increases the expense and X-ray exposure times of PVP.