经皮椎体成形术和后凸成形术的相关问题探讨  

Assessment of percutaneous vertebroplasty and kyphoplasty

作　　者：徐宝山[1] 胡永成[1] 闫广辉[1] 夏群[1] 黄震源[1] 吉宁[1] 张继东[1] 苗军[1] 宁尚龙[1] 谭清实[1] 周静[1] 

机构地区：[1]天津医院脊柱外科,300211

出　　处：《中华骨科杂志》2009年第5期430-435,共6页Chinese Journal of Orthopaedics

摘　　要：目的探讨经皮椎体成形术（percutaneous vertebroplasty，PVP）和经皮椎体后凸成形术（percutaneous kyphoplasty，PKP）的疗效、并发症及适应证。方法2000年2月至2008年2月行PVP和PKP治疗椎体疼痛性血管瘤、溶骨性肿瘤和骨质疏松性骨折178例，其中PVP115例，PKP63例。结果（1）16例血管瘤（PVP14例，PKP2例）灌注剂均无明显渗漏，优良率87．5％。（2）68例恶性肿瘤均行PVP，灌注剂渗漏率27．9％，除2例椎管内少量渗漏引起一过性神经根性症状外，其他渗漏均未引起临床症状，优良率70．6％。43例平均随访10个月，9例病情恶化致疼痛复发，其他患者疗效稳定。（3）94例骨质疏松性骨折中33例行PVP，61例行PKP，灌注剂渗漏率PVP为18．2％，PKP为9。8％，均未引起临床症状；PVP复位效果不明显，PKP均能在椎体内扩张造成空腔，椎体前缘高度平均恢复34．2％，Cobb角平均矫正3．3°；PVP和PKP疗效差异无统计学意义，优良率92．6％；64例平均随访3年，2例PKP相邻椎体骨折再次PKP后好转，其余患者疗效无明显变化。结论椎体疼痛性血管瘤、溶骨性肿瘤和骨质疏松性骨折是PVP和PKP的主要适应证；对骨质疏松性骨折行PKP可压缩周围松质骨骨折造成空腔，减少灌注剂渗漏，部分恢复椎体高度和角度。Objective To evaluate the results, indication and complication of percutaneous vertebroplasty（PVP） and pereutaneous kyphoplasty（PKP）. Methods From February 2000 to February 2008, 178 patients were treated for symptomatic vertebral haemangioma, osteolytic neoplasm, or osteoporotie fractures, including PVP for 115 eases and PKP for 63 eases. Results 1） There were 16 patients of symptomatic haemangioma, and 14 underwent PVP while the other 2 eases were performed PKP. No evident cement leakage was found, and excellent or good results were obtained in 87.5% of them. 2） For the 68 patients of osteolytic neoplasm, posterior wall of vertebrae wall was involved in 28 eases, and all of them were treated with PVP. Cement leakage was detected in 27.9% patients with CT. However, there were only 2 patients of epidural leakage experienced transitory radicular pain. At the latest follow up, the excellent and good rate of results was 70.6%. Forty-three patients were followed for an average of 10 months. Although pain relief was still obvious in 34 cases, there were 9 patients complained recurrence of pain due to the deterioration of the tumor. 3） For the 94 patients of osteoporotic fracture, posterior vertebral wall was involved in 29 cases. All of them, 33 cases were treated with PVP while the other 61 cases were dealt with PKP. Cement leakages were detected in 18.2% patients for PVP, and 9.8% patients for PKP, but no clinical symptom was complained. For PKP, the reduction of anterior vertebral body height averaged 34.2%, and correction of Cobb angle averaged 3.3°, while no evident reduction was detected for PVP. Excellent or good results were obtained in 92.6% of patients, while no significant difference was found between PVP and PKP. Sixty-four patients were followed for an average of 3 years. Two patients with PKP encountered adjacent vertebral fracture, which was treated by another PKP with good results, and the clinical results were sustained in the others. Conclusion The indications of PVP or PKP mainly cons

关 键 词：脊柱骨折 脊椎穿刺 肿瘤 

分 类 号：R686[医药卫生—骨科学]