【摘要】 目的 探討CT引導下經椎弓根穿刺活檢對椎體病變的診斷價值及可行性。 方法 回顧性分析2009年5月—2010年4月42例椎體病變患者經椎弓根穿刺活檢的穿刺活檢方法、病理結果、最終診斷及穿刺并發癥。 結果 患者總穿刺準確率為95.2%（40/42）。其中惡性病變的穿刺準確率為94.3%（33/35），良性病變穿刺準確率為100%（7/7）；所有患者均未發生嚴重穿刺并發癥。 結論 CT引導下經椎弓根穿刺活檢診斷椎體病變有安全可靠、準確性高等特點。【Abstract】 Objective To explore the value and the feasibility of CT guided transpedicular biopsy in diagnosing vertebral body lesions. Methods From May 2009 to April 2010, 42 patients with vertebral body lesions underwent CT guided transpedicular biopsy. The clinical data including the puncture method, pahtological resutls, final diagnosis, and the pucture complications were retrospectively analyzed. Results The total accuracy rate of the puncture was 95.2%(40/42). The accuracy rate of the puncture was 94.3% (33/35) for malignant lesions and 100.0% (7/7) for benign lesions. No complication occurred. Conclusion CT guided transpedicular biopsy is very helpful in diagnosing vertebral body lesions with high accuracy and fewer complications.
Objective To investigate the feasibil ity, safety and operative techniques of percutaneous vertebroplasty (PVP) in treating osteolytic bone metastasis of cervical vertebra and reconstructing the function of cervical vertebra. Methods From March 2005 to December 2007, 10 patients with osteolytic bone metastatic carcinoma in single cervical vertebral body received PVP, including 5 males and 5 females aged 38-75 years (mean 54.5 years). Among them, 5 patients had primary lung tumor, 1 primary renal tumor, 1 primary breast tumor, 1 primary cervical tumor and 2 unknown primary lesion. The course of disease was 2-4 years. All the patients suffered from obviously cervical pain and l imitation of activity, including 4 cases of metastatic tumor of the C2 vertebral body, 2 of C3, 2 of C6 and 2 of C7. The general condition of patients was stable before operation, and no blood coagulation dysfunction, radiculalgia and spinal cord compression were detected. Lateral PVP was performed on 6 cases, approaching between the vertebral artery and the carotid sheath under CT guidance and anterolateral PVP was performed on the rest 4 cases, approaching between the trachea and the internal carotid artery under continuously X-ray fluoroscopy. The amount of bone cement injected was 3-4 mL, and the fill ing rate was 50%-100%. Results Without obvious bleeding or organ injury, the puncture was performed successfully on all the patients. Without symptom of spinal cord compression, patients suffered from pain during operation (1 case) and such compl ications noted by immediate CT or X-rays examination after operation as paravertebral epidural cement leakage (2 ases),transverse foramen cement leakage (1 case) and pinhole reflux (3 cases). The pain of patients was improved to various degree postoperatively, the visual analogue scales score was (5.9 ± 1.2) points before operation, which was changed to (2.6 ± 1.2) points at 1 hour after PVP and (1.6 ± 1.3) points at 1 week after PVP, indicating there was a significant difference between pre- and postoperation (P lt; 0.05). During the regular follow-up at 1 week, 3 and 12 months after PVP, all patients had no dislocation of cervical vertebra body, spinal cord compression and paralysis. Five patients died from multiple organ failure due to primary tumor progression, including 3 cases at 6 months after PVP and 2 at 12 months after PVP, and the rest 5 patients’ cervical pain were under control, with sound functional recovery. Conclusion PVP can rel ieve pain quickly and reinforce the stabil ity of the vertebral body, and has sl ight compl ications; the lateral approach is safe and effective.
