组合式微创手术治疗胸椎侵袭性血管瘤  

Combined minimally invasive surgery for invasive vertebral hemangioma in thoracic spine

作　　者：韩念荣 田育魁 刘岩路[1] 艾克热木·吾斯曼 黄异飞[1] 胡炜[1] HAN Nian-rong;TIAN Yu-kui;LIU Yan-lu;IkeRemu-Wuseman;HUANG Yi-fei;HU Wei(Department of Spinal Surgery,Affiliated Hospital of Traditional Chinese Medicine,Xinjiang Medical University,Urumqi 830000,China;Department of Massage,Affiliated Hospital of Traditional Chinese Medicine,Xinjiang Medical University,Urumqi 830000,China)

机构地区：[1]新疆医科大学附属中医医院脊柱二科,新疆乌鲁木齐830000 [2]新疆医科大学附属中医医院推拿科,新疆乌鲁木齐830000

出　　处：《中国矫形外科杂志》2024年第17期1605-1608,共4页Orthopedic Journal of China

基　　金：新疆维吾尔自治区自然科学基金-青年科学基金项目(编号:2022D01C815)。

摘　　要：[目的]介绍组合式微创手术治疗胸椎侵袭性血管瘤的手术技术和初步临床结果。[方法]患者术前行脊髓动脉造影了解椎管内占位病变血供情况,并采用弹簧圈栓塞供血动脉。患者俯卧位,透视定位,局麻后经皮穿刺针沿椎弓根进针到达椎体目标位置,建立工作通道,插入一次性使用可弯曲骨水泥填充套件,反复透视下间断缓慢推入骨水泥,填充整个病变椎体。局麻后置入椎间孔镜工作通道,插入环钻将椎间孔扩大成形。将操作套管推入病变椎体后缘,镜下摘除椎管内占位组织,并探查硬脊膜搏动情况。留置引流并缝合固定。[结果]患者术后腰背部疼痛VAS评分0分,右下肢肌力恢复至4级+。术后1周影像显示椎管内血管瘤约60%被摘除,术区渗出明显;与术后1周对比,术后4个月椎管内未完全摘除的血管瘤逐渐皱缩,未见明显复发增大改变,受压脊髓明显恢复,且术区渗出完全吸收。[结论]组合式微创手术方式为胸椎侵袭性血管瘤的微创治疗方法提供了新思路与技术方法,初步治疗效果良好。[Objective]To introduce the surgical technique and preliminary clinical results of combined minimally invasive surgery for the treatment of invasive vertebral hemangioma in the thoracic spine.[Methods]The patients received spinal artery angiography before surgery to understand the blood supply of the lesions in the spinal canal,and the blood supply artery was embolized by spring coil.The patient was placed in prone position with fluoroscopic positioning performed.After local anesthesia,percutaneous puncture needles were inserted along the pedicle to reach the target location of the vertebral body,and then a working channel was established.Disposable flexible bone cement filling kit was inserted,and the bone cement was slowly pushed into the entire lesion aera under repeated fluoroscopy.In addition,the transforaminal endoscope working channel was established under local anesthesia,and a trephine was inserted to enlarge and shape the foramina.The operating cannula was pushed into the posterior margin of the involved vertebra,the occupying tissue in the spinal canal was removed under the endoscope until the dural pulsation was observed.Finally,a drainage tube was placed and the wound was sutured.[Results]The patients got significant pain relief with VAS score of 0 postoperatively,while had muscle strength of the right lower limb recovered to grade 4+.Images 1 week after surgery showed about 60%of intraspinal hemangioma removed,with obvious operative area exudation.The remnant of hemangioma shrinked gradually 4 months after surgery compared with that preoperatively,no significant recurrence or increase was observed,the spinal cord recovered significantly under compression,and the operative area exudation was completely absorbed.[Conclusion]This combined minimally invasive surgery provides a new idea and technique of the minimally invasive treatment for invasive vertebral hemangioma in thoracic spine,and achieves satisfactory primary clinical outcome.

关 键 词：椎体血管瘤 经皮椎体成形 椎间孔镜 微创手术 

分 类 号：R738.1[医药卫生—肿瘤]