St Lukes Radiology, St Lukes Hospital, Latimer Rd, Headington, Oxford, OX3 7PF, UK.
Eur Radiol. 2013 Jul;23(7):1785-90. doi: 10.1007/s00330-013-2787-0. Epub 2013 Feb 27.
Coblation to create a cavity in the affected vertebral body was performed for complex fractures and/or when there was a posterior wall defect. This permitted a low-pressure injection and potentially reduces the risk of extravasation of cement into the spinal canal.
Prospective audit for outcome measures and complications allowed retrospective review of cases treated by coblation. A commercial wand inserted via a wide-bore vertebroplasty needle created a cavity before inserting cement. A visual analogue scale assessed pain and Roland Morris scoring assessed mobility.
Thirty-two coblation procedures were performed. Primary diagnoses were myeloma, metastases, osteoporosis and trauma. Outcome measures were recorded with a 56 % success rate, 6 % no change and 32 % with mixed but mainly positive results; 6 % died before follow-up. No complications were observed; in particular no patient suffered neurological damage and none have developed subsequent fractures at the treated levels.
This technique makes possible cementation of patients who would otherwise be unsuitable for vertebroplasty. The modest pain and disability improvement is partly due to our stringent criteria as well as fracture complexity. Further work will assess the efficacy of the method compared with conservative measures.
• Treatment of vertebral compression fractures with possible posterior wall defects is controversial. • Coblation before vertebroplasty allows a low-pressure injection into fractured vertebrae. • This technique reduces risk of extravasation of cement. • No serious complication of our coblation procedures was observed.
对于复杂骨折和/或存在后侧壁缺陷的病例，采用电切钻在受累椎体中造腔，以便在低压下注射骨水泥，从而降低水泥外渗进入椎管的风险。
通过前瞻性审核对结局指标和并发症进行评估，对采用电切钻治疗的病例进行回顾性分析。通过宽口径骨水泥注入针插入商用电切钻，在插入骨水泥之前先造腔。采用视觉模拟评分法（VAS）评估疼痛，采用 Roland-Morris 评分评估活动能力。
共行 32 例电切钻手术。主要诊断为骨髓瘤、转移瘤、骨质疏松症和外伤。56%的病例获得了显著疗效，6%的病例疗效无变化，32%的病例疗效混合但主要为阳性；6%的病例在随访前死亡。未观察到并发症；特别是无任何患者发生神经损伤，也无任何患者在治疗水平发生后续骨折。
对于那些否则不适合行椎体成形术的患者，该技术可实现骨水泥固定。疼痛和残疾的适度改善部分归因于我们严格的纳入标准，以及骨折的复杂性。进一步的研究将评估该方法与保守治疗相比的疗效。
• 存在后侧壁缺陷的椎体压缩性骨折的治疗存在争议。
• 椎体成形术前行电切钻可在骨折椎体中进行低压注射。
• 该技术可降低水泥外渗的风险。
• 我们的电切钻手术未观察到严重并发症。
