Martin J B, Jean B, Sugiu K, San Millán Ruíz D, Piotin M, Murphy K, Rüfenacht B, Muster M, Rüfenacht D A
Department of Neuroradiology, University Hospital HUG, University of Geneva, Switzerland.
Bone. 1999 Aug;25(2 Suppl):11S-15S. doi: 10.1016/s8756-3282(99)00126-x.
This study was undertaken to report the clinical experience with percutaneous minimal invasive vertebroplasty using polymethyl-methacrylcate (PMMA) for a consecutive group of patients. Over the period of the last 4 years, 40 patients were treated at 68 vertebral segment levels with the intention to relieve pain related to vertebral body lesions. Reduced vertebral body height and destruction of the posterior vertebral wall were not considered to be exclusion criterias. The vertebroplasty procedure was performed under general anesthesia and in prone position with imaging control using mostly biplane DSA fluoroscopic guidance, and rarely with single-plane mobile DSA combined with computed tomographic guidance. Unilateral, but more frequently bilateral, transpedicular introduction of a 2-3-mm OD needle was followed by an injection of polymethyl-methacrylcate (PMMA). PMMA preparation involved a diluted mixture (20 mL powder for 5 mL liquid) allowing for an extended polymerization time of up to 8 min. The PMMA was mixed with metallic powder to enhance its radio-opacity. Before PMMA injection, a vertebral phlebography was obtained to evaluate the filling pattern and identify sites of potential PMMA leakage. Injection of opacified PMMA was performed under continuous visual control with fluoroscopy to obtain adequate filling and to avoid important PMMA leakage. Clinical follow-up involved an evaluation using a questionnaire for assessment of pain, pain medication, and mobility. One to six levels were treated in one to three treatment sessions for patients with metastatic, osteoporotic, and hemangiomatous lesions of the vertebral bodies who presented with pain. The results observed matched those reported previously with a success rate of approximately 80% and a complication rate below 6% per treated level. Treatment failure and complications observed were related to leakage, insufficient pretreatment evaluation, anesthesia, or patient position during treatment. Image guidance with fluoroscopy was efficient both for precise transpedicular approach and PMMA implantation control. Vertebroplasty is very efficient for treatment of pain. Treatment failure was mostly related to insufficient pretreatment clinical evaluation, and complication due to excessive PMMA volume injection. Control of PMMA volume seems to be the most critical point for avoiding complications. A good fluoroscopy control is therefore mandatory.
本研究旨在报告一组连续患者使用聚甲基丙烯酸甲酯（PMMA）进行经皮微创椎体成形术的临床经验。在过去4年期间，对40例患者的68个椎体节段进行了治疗，目的是缓解与椎体病变相关的疼痛。椎体高度降低和椎体后壁破坏不被视为排除标准。椎体成形术在全身麻醉下进行，患者俯卧位，主要使用双平面数字减影血管造影（DSA）透视引导进行影像控制，很少使用单平面移动DSA结合计算机断层扫描引导。通过单侧（但更常见的是双侧）经椎弓根插入外径为2 - 3毫米的针，随后注入聚甲基丙烯酸甲酯（PMMA）。PMMA制剂采用稀释混合物（20毫升粉末对5毫升液体），使聚合时间延长至8分钟。将PMMA与金属粉末混合以增强其射线不透性。在注入PMMA之前，进行椎体静脉造影以评估充盈模式并确定潜在的PMMA渗漏部位。在透视连续视觉控制下注入造影剂的PMMA，以获得充分的填充并避免重要的PMMA渗漏。临床随访包括使用问卷评估疼痛、止痛药物和活动能力。对出现疼痛的椎体转移性、骨质疏松性和血管瘤性病变患者，在1至3个治疗疗程中治疗1至6个节段。观察到的结果与先前报道的结果相符，成功率约为80%，每个治疗节段的并发症发生率低于6%。观察到的治疗失败和并发症与渗漏、术前评估不足、麻醉或治疗期间患者体位有关。透视影像引导对于精确的经椎弓根入路和PMMA植入控制均有效。椎体成形术在治疗疼痛方面非常有效。治疗失败主要与术前临床评估不足以及因PMMA注入量过多导致的并发症有关。控制PMMA注入量似乎是避免并发症的最关键点。因此，必须进行良好的透视控制。
