CT引导下经皮穿刺椎体成形术的初步应用  

CT-guided percutaneous vertebroplasty

作　　者：邓忠良[1] 谢维波[2] 任广军[1] 陈富[1] 黄朝梁[1] 周言忠[1] 

机构地区：[1]重庆医科大学附属第二医院骨科,400010 [2]重庆医科大学附属第二医院放射科,400010

出　　处：《重庆医学》2002年第12期1159-1160,共2页Chongqing medicine

摘　　要：目的　探讨CT引导下行经皮穿刺椎体成形术的特点和疗效。方法　 8例 (13个椎体 )腰背痛患者 ,其中 7例 (12椎 )骨质疏松性椎体压缩骨折 ,1例 (1椎 )椎体恶性肿瘤。在CT定位及引导下进行经皮穿刺椎体成形术。术中间断扫描调整穿刺针位置及注射聚甲基丙烯酸甲酯骨水泥。记录手术时间及骨水泥注射量 ,术毕CT扫描了解骨水泥分布。用疼痛视觉模拟评分法(VAS)进行疗效评估 ,随访 2～ 5个月 (平均 4个月 )。结果　 8例 (13个椎体均穿刺成功 ,骨水泥注射量 0 .5～ 2 .8ml,平均 (1.9±0 .6 )ml,手术时间每椎体 85～ 15 0min[平均 (118± 30 )min]。出现骨水泥少量椎管内硬膜外静脉内漏 1椎 ,无临床症状。止痛效果 8例有效 ,VAS术前 7.8± 1.1,术后 2 4h3.8± 1.3,与术前比较明显减轻 (P <0 .0 5 ) ,平均术后 4月随访VAS 2 .9± 1.8,显示疗效维持。结论　经皮穿刺椎体成形术有明显止痛效果。CT引导下进行该手术具有穿刺准确的优点 ,但不能实时监测骨水泥注射情况和手术耗时较长。Objective To evaluate the effects and technique of percutaneous vertebroplasty(PVP) guided by CT. Methods Eight cases(13 vertebrae) suffering from osteoporotic vertebral compression fracture (7 cases, 12 vertebrae) or vertebral malignant tumor (one case, one vertebra) underwent percutaneous vertebroplasty guided by CT. Polymethylmethacrylate(PMMA) was injected into lesion vertebral bodies during PVP. Vasual analogic scale(VAS) was measured in each patient at the time before operation, 24hrs after operation and follow up. All cases were followed up 2 to 5 months (mean 4 months). Results PVP was successful in procedure. The amount of PMMA injected into each vertebral body is from 0.5ml to 2.8ml[mean(1.9±0.6)ml]. Time consumed for PVP in each vertebra was from 85 minutes to 150 minutes(mean 118 minutes). Asymptomatic PMMA leakage into spinal canal was demonstrated by CT in one case. Pain decreased in all patients. VAS was decreased from 7.8±1.1(mean±standard deviation) before operation to 3.8±1.3 at 24 hours postoperatively( P <0.01). Improvement was observed within 2 to 5 months follow up (VAS maintained 2.9±1.8). Conclusion PVP is a minimally invasive procedure and provides significant pain relief. CT guidance allows accurate needle placement. However, CT guidance alone is the lack of real time visualization of cement injection and needs more time during procedure.

关 键 词：经皮穿刺椎体成形术 CT 骨水泥 PVP 疗效 

分 类 号：R687.3[医药卫生—骨科学]