CAJ | 학술논문

目的探讨经皮椎体成形术(pereutaneous vertebroplasty,PVP)和经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)的疗效,并发症及适应证.方法 2000年2月至2008年2月行PVP和PKP治疗椎体疼痛性血管瘤、溶骨性肿瘤和骨质疏松性骨折178例,其中PVP 115例,PKP 63例.结果 (1)16例血管瘤(PVP 14例,PKP 2例)灌注剂均无明显渗漏,优良率87.5%.(2)68例恶性肿瘤均行PVP,灌注剂渗漏率27.9%,除2例椎管内少量渗漏引起一过性神经根性症状外,其他渗漏均未引起临床症状,优良率70.6%.43例平均随访10个月,9例病情恶化敛疼痛复发,其他患者疗效稳定.(3)94例骨质疏松性骨折中33例行PVP,61例行PKP,灌注剂渗漏率PVP为18.2%,PKP为9.8%,均未引起临床症状;PVP复位效果不明显,PKP均能在椎体内扩张造成空腔,椎体前缘高度平均恢复34.2%,Cobb角平均矫正3.3°;PVP和PKP疗效差异无统计学意义,优良率92.6%;64例平均随访3年,2例PKP相邻椎体骨折再次PKP后好转,其余患者疗效无明显变化.结论椎体疼痛性血管瘤、溶骨性肿瘤和骨质疏松性骨折是PVP和PKP的主要适应证;对骨质疏松性骨折行PKP呵压缩周围松质骨骨折造成空腔,减少灌注剂渗漏.部分恢复椎体高度和角度.
목적 탐토경피추체성형술(pereutaneous vertebroplasty,PVP)화경피추체후철성형술(percutaneous kyphoplasty,PKP)적료효,병발증급괄응증.방법 2000년2월지2008년2월행PVP화PKP치료추체동통성혈관류、용골성종류화골질소송성골절178례,기중PVP 115례,PKP 63례.결과 (1)16례혈관류(PVP 14례,PKP 2례)관주제균무명현삼루,우량솔87.5%.(2)68례악성종류균행PVP,관주제삼루솔27.9%,제2례추관내소량삼루인기일과성신경근성증상외,기타삼루균미인기림상증상,우량솔70.6%.43례평균수방10개월,9례병정악화렴동통복발,기타환자료효은정.(3)94례골질소송성골절중33례행PVP,61례행PKP,관주제삼루솔PVP위18.2%,PKP위9.8%,균미인기림상증상;PVP복위효과불명현,PKP균능재추체내확장조성공강,추체전연고도평균회복34.2%,Cobb각평균교정3.3°;PVP화PKP료효차이무통계학의의,우량솔92.6%;64례평균수방3년,2례PKP상린추체골절재차PKP후호전,기여환자료효무명현변화.결론 추체동통성혈관류、용골성종류화골질소송성골절시PVP화PKP적주요괄응증;대골질소송성골절행PKP가압축주위송질골골절조성공강,감소관주제삼루.부분회복추체고도화각도.
Objective To evaluate the results, indication and complication of percutaneous vertebroplasty(PVP) and percutaneous kyphoplasty(PKP). Methods From February 2000 to February 2008, 178 patients were treated for symptomatic vertebral haemangioma, osteolytic neoplasm, or osteoporotic fractures, including PVP for 115 cases and PKP for 63 cases. Results 1) There were 16 patients of symptomatic haemangioma, and 14 underwent PVP while the other 2 cases were performed PKP. No evident cement leakage was found, and excellent or good results were obtained in 87.5% of them. 2) For the 68 patients of osteolytic neoplasm, posterior wall of vertebrae wall was involved in 28 cases, and all of them were treated with PVP. Cement leakage was detected in 27.9% patients with CT. However, there were only 2 patients of epidural leakage experienced transitory radicular pain. At the latest follow up, the excellent and good rate of results was 70.6%. Forty-three patients were followed for an average of 10 months. Although pain relief was still obvious in 34 cases, there were 9 patients complained recurrence of pain due to the deterioration of the tumor. 3) For the 94 patients of osteoporotic fracture, posterior vertebral wall was involved in 29 cases. All of them, 33 cases were treated with PVP while the other 61 cases were dealt with PKP. Cement leakages were detected in 18.2% patients for PVP, and 9.8% patients for PKP, but no clinical symptom was complained. For PKP, the reduction of anterior vertebral body height averaged 34.2%, and correction of Cobb angle averaged 3.3~, while no evident reduction was detected for PVP. Excellent or good results were obtained in 92.6% of patients, while no significant difference was found between PVP and PKP. Sixty-four patients were followed for an average of 3 years. Two patients with PKP encountered adjacent vertebral fracture, which was treated by another PKP with good results, and the clinical results were sustained in the others. Conclusion The indications of PVP or PKP mainly consist of symptomatic haemangioma, osteolytic neoplasm and osteoporotic fracture. The similar satisfactory clinical results can be obtained and sustained after these two procedures. For osleoporotie fractures, PKP can produce void in the vertebral body and reduce the cement leakage, however, only partially restore vertebral body height.