Gaughen John R, Jensen Mary E, Schweickert Patricia A, Kaufmann Timothy J, Marx William F, Kallmes David F
Department of Radiology, University of Virginia Health Services, Charlottesville 22908, USA.
AJNR Am J Neuroradiol. 2002 Apr;23(4):594-600.
Controversy exists regarding the utility of antecedent venography in percutaneous vertebroplasty. Our purpose was to determine whether antecedent venography improves clinical outcomes and/or decreases extravertebral cement extravasation in these procedures.
We retrospective reviewed outcomes of consecutive percutaneous vertebroplasty procedures performed at our institution to define two populations, each consisting of 24 patients treated at 42 vertebral levels. Group 1 included patients who underwent antecedent venography, and group 2 included patients treated without venography. Clinical outcomes were assessed with quantitative measurements of pain and mobility. Venograms and postprocedural radiographs were interpreted to evaluate the number of vertebrae with extravertebral cement extravasation, degree of extravasation at each level, and correlation between venography and vertebroplasty.
Pain improved in 19 of 20 group 1 patients, compared with 21 of 22 group 2 patients; mean postoperative pain levels were 1.3 and 1.8, respectively (P =.50), on a scale of 0 (no pain) to 10 (worst pain). All 11 group 1 patients with impaired preoperative mobility reported postoperative improvement, as did all 12 group 2 patients; mean levels of postoperative impaired mobility for groups 1 and 2 were 0.35 and 0.27, respectively (P =.43). Twenty-two of 42 vertebrae treated in group 1 demonstrated extravasation, compared with 28 of 42 in group 2 (P =.266); amounts of extravasation did not differ. Among 22 levels of extravasation in group 1, venograms in 14 showed correlative extravasation.
Antecedent venography does not significantly improve the effectiveness or safety of percutaneous vertebroplasty performed by qualified, experienced operators.
关于先行静脉造影在经皮椎体成形术中的作用存在争议。我们的目的是确定先行静脉造影是否能改善这些手术的临床疗效和/或减少椎体外骨水泥渗漏。
我们回顾性分析了在我们机构进行的连续经皮椎体成形术的结果，以确定两组人群，每组由24例患者、共42个椎体节段接受治疗。第1组包括接受先行静脉造影的患者，第2组包括未进行静脉造影而接受治疗的患者。通过对疼痛和活动度的定量测量来评估临床疗效。解读静脉造影片和术后X线片，以评估出现椎体外骨水泥渗漏的椎体数量、每个节段的渗漏程度以及静脉造影与椎体成形术之间的相关性。
第1组20例患者中有19例疼痛得到改善，而第2组22例患者中有21例疼痛得到改善；术后平均疼痛水平分别为1.3和1.8（P = 0.50），疼痛评分范围为0（无疼痛）至10（最严重疼痛）。第1组术前活动度受损的11例患者术后均报告有改善，第2组的12例患者也是如此；第1组和第2组术后活动度受损的平均水平分别为0.35和0.27（P = 0.43）。第1组治疗的42个椎体中有22个出现渗漏，而第2组42个椎体中有28个出现渗漏（P = 0.266）；渗漏量无差异。在第1组的22个渗漏节段中,14例静脉造影片显示有相关渗漏。
对于由合格、有经验的操作人员进行的经皮椎体成形术，先行静脉造影并不能显著提高其有效性或安全性。
