再次椎体成形术的应用

目的探讨再次经皮椎体成形术(PVP)处理首次PVP术后疼痛不缓解的可行性、方法及疗效。方法骨质疏松症并椎体压缩骨折9例共9节行PVP治疗后疼痛不缓解，其中轻度压缩3例、中度以上压缩6例，包括合并囊性积液4例4节和粉碎性压缩2例2节；椎体转移性肿瘤4例共5节行经皮椎体成形术治疗后2～4个月疼痛复发。均采用再次PVP治疗，术后CT观察PMMA分布状况和有无渗漏，并进行临床疗效评价和观察有无并发症。结果再次PVP技术均成功，再注入PMMA量平均为4．8ml，随访1～18个月，CR10例、PR3例。CT证实椎体周围PMMA渗漏2例，但无一例出现临床症状。2例椎体转移肿瘤分别于再次PVP后4、5个月死亡，但无明显相应病变椎体平面疼痛。结论对骨质疏松性椎体压缩骨折PVP后疼痛不缓解及椎体内转移性肿瘤疼痛复发者，再次PVP的疗效显著。关键技术是经椎弓根穿刺至椎体内致痛区并充分充填PMMA。

Re-vertebroplasty: clinical experience and follow-up results

Objective To evaluate the feasibility, methods and clinical efficacy of re-vertebroplasty for un-relief pain or recurrence after previous treatment with vertebroplasty.Methods Nine vertebrae of osteoporotic compression fractures in 9 patients with un-relief pain and 5 vertebrae of metastasis in 4 patients with pain recurrence after vertebroplasty were treated by re-vertebroplasty. CT was done after PMMA injection to observe PMMA distribution in vertebrae and whether having leakage or not. The efficacy of re-vertebroplasty was evaluated during follow-up. Results The successful rate of technique of re-vertebroplasty was 100%. 4.8ml of PMMA in average was injected in each vertebra. CR and PR were obtained respectively in 10 and 3 cases during 1-4 months of follow-up. No serious complications related to the technique occurred, except 2 cases with asympotomatic PMMA leakage around vertebrae demonstrated by CT.Conclusions Significant pain relief after re-vertebroplasty in the treatment of patients with pain un-relief or recurrence after previous vertebroplasty, with low rate of PMMA leakage. The important technique lies on the assurance of sufficient PMMA filling in the vertebral pain caused area preventing future motion .