经皮椎体后凸成形术治疗疼痛性椎体血管瘤的临床疗效  

The clinical efficacy of percutaneous kyphoplasty in the treatment of painful vertebral hemangioma

作　　者：谢计乐 王根林[1] 章戈[1] 朱雪松[1] 姜为民[1] 杨惠林[1] 

机构地区：[1]苏州大学附属第一医院骨科,江苏苏州215006

出　　处：《骨科》2017年第3期163-166,共4页ORTHOPAEDICS

基　　金：国家自然科学基金(81271960)

摘　　要：目的探讨经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗疼痛性椎体血管瘤(vertebral hemangioma,VH)的临床疗效。方法回顾性分析2008年1月至2016年8月于我科行PKP治疗VH的病人的临床资料。本组30例中,男6例,女24例,平均年龄为(62.0±12.6)岁;血管瘤位于胸椎18例、腰椎9例、胸椎合并腰椎多发者3例,共累计34个椎体,其中2个椎体血管瘤合并椎体压缩骨折。应用疼痛视觉模拟量表(visual analogue scale,VAS)评估病人疼痛情况,采用Oswestry功能障碍指数(Oswestry disability index,ODI)评估病人的生活质量,并记录术后并发症。结果本组病人均顺利完成手术,其中双侧穿刺28个椎体,单侧穿刺6个椎体,平均随访时间为(14.77±4.98)个月。两组病人术前、术后24 h、术后1个月及末次随访时的VAS评分分别为(5.63±1.52)分、(1.31±1.06)分、(0.88±0.82)分、(0.69±0.58)分;各时间点的ODI分别为(61.09±18.95)%、(21.72±10.57)%、(12.66±9.10)%、(9.31±5.60)%,两组病人术后的VAS评分及ODI均较术前明显下降,与术前比较,差异均有统计学意义(P均<0.05)。术后4例椎体出现椎旁骨水泥渗漏,无临床症状;1例病人术后8个月因骨质疏松出现邻近椎体骨折,再次行PKP术;1例92岁病人术后1年自然死亡。术后影像学资料未显示有VH复发。结论对于无神经压迫、以疼痛为主要症状的VH,PKP具有良好的安全性和治疗效果,且对合并椎体压缩性骨折的VH病人同样有效。Objective To investigate the clinical efficacy of percutaneous kyphoplasty(PKP) in thetreatment of symptomatic vertebral hemangioma(VH).Methods From January 2008 to August 2016,a total of30 patients with symptomatic VH treated with kyphoplasty in our hospital were enrolled in this retrospectivestudy.This study involved 6 males and 24 females,with mean age of 62.0±12.6 years old.There were 18 casesof thoracic lesion,9 cases of lumbar lesion,and 3 cases of mixed regions.Thirty-four vertebral bodies wereinvaded.Two cases had combined osteoporotic compression vertebral fracture and VH in the same vertebralbody.Visual analogue scale(VAS) was used to assess pain in patients.Oswestry disability index(ODI) scalewas used to assess the quality of life,and postoperative complications were recorded.Results All 30 patientsreceived successful PKP.We performed bilateral PKP on 28 vertebral bodies and unilateral PKP on 6 vertebralbodies.All patients were followed up at mean time of(14.77±4.98) months.VAS score was 5.63±1.52 beforeoperation,1.31±1.06 at 24 h after operation,0.88±0.82 at 1 month after operation and 0.69±0.58 at last follow-up.ODI score was(61.09±18.95)% before operation,(21.72±10.57)% at 24 h after operation,(12.66±9.10)% at1 month after operation and(9.31±5.60)% at last follow-up.The VAS and ODI scored after operation weresignificantly lower than those before surgery(P<0.05 for all).Four cases presented a para-vertebral bodycement leakage,without clinical symptoms.One case presented vertebral compression fracture at adjacentvertebrae and received PKP.One 92-year-old case presented natural death.Postoperative radiographic data did not show recurrence of VH.Conclusion For the painful symptomatic VH without nerve injury,PKP is goodand effective.PKP is also effective in treating VH combined with vertebral compression fracture.

关 键 词：血管瘤 脊柱 椎体成形术 椎体后凸成形术 

分 类 号：R738[医药卫生—肿瘤]