治療因骨質疏鬆所引起的脊椎壓迫性骨折：脊椎整形術

Percutaneous Vertebroplasty for the Treatment of Osteoporotic Vertebral Compression Fracture

吳佩珍(Pei-Cheng Wu) ； 鍾國晃(Gwo-Hoang Chung) ； 張宸誌(Chen-Jyh Chan) ； 陳信文(Hsin-Wen Chen) ； 嚴寶勝(Pau-Sen Yen)

《中華放射線技術學雜誌》 27卷2期 (2003/12) Pp. 131-136

摘要

脊椎整形術(Vertebroplasty)就是利用骨水泥以填充因嚴重性骨質疏鬆所引起之脊椎壓迫性骨折的一種新治療方法，它能有效的減輕病患的疼痛，並強化因疾病而變脆弱的椎體。脊椎整形術必需在無菌環境下進行，並施予局部麻醉或由靜脈注射強效止痛劑。先請患者俯臥於手術台上，用優碘(betadine)消毒背後局部的皮膚，並鋪上無菌治療巾，在X光的透視下，將骨髓穿刺套針(bone marrow biopsy needle, size : Gr# 12-10 cm) 經背部穿刺進入受損的椎體內，視情況而加做活體組織切片檢查，以提供此受損椎體的病理分析，必要時可接上心電圖、血壓、血氧含量(oximetry)等儀器，以監視病人的情況是否穩定。隨後在X光透視的引導下，將聚甲基異丁烯酸(Polymethylmethacrylate, PMMA)，或稱人工骨水泥(bone cement)的物質，經由椎腳(pedicle)慢慢注入到受損的椎體內，藉以填充椎體疏鬆處及骨裂處，並強化此椎體，等骨水泥變硬且足以支撐脊椎架構時，手術即結束。此項技術可同天做多節椎體，而每節椎體平均所需的治療時間約一小時左右，且因椎體所填入的人工骨泥會在10分鐘內完全硬化，所以在治療過程需迅速確實，並小心謹慎。

關鍵字

脊椎整形術 ； 脊椎壓迫性骨折 ； 聚甲基異丁烯酸 ； 骨水泥 ； 骨髓穿刺套針

並列摘要

Vertebroplasty is a new procedure that using bone cement for the treatment of osteoporotic vertebral compression fracture. That provides pain relief and strengthening of the bone of vertebral weakened by disease. Vertebroplasty must be performed with strict sterile conditions, partial anesthesia with 2 % xylocaine or infusion fentanyl into the vein. First, place the patient prone on the fluoroscopy table. The partial skin overlying the vertebral body was sterilized by betadine and draped. Under fluoroscopic, the biopsy needle was pushed and through the skin into the injury of the vertebral body. Sometime, a biopsy can precede the cement injection. The patient’s electrocardiogram, blood pressure, oximetry were monitored continuously. With fluoroscopic guidance, trans pedicle injection of the PMMA(Polymethyl methacrylate) or bone cement into the injury of the vertebral body. It could fill the osteoporotic vertebral compression fracture and strengthening of the bone of vertebral. The treatment was complete when bone cement became solid. This technique can be using with multiple of the vertebral body on the same day, and average of the treatment time about one hour by each of the vertebral body. The procedure for the treatment must be quickly and carefully, because the bone cement would become solid in ten minute.

並列關鍵字

Vertebroplasty ； vertebral compression crush fracture ； Polymethylmethacrylate(PMMA) ； bone cement, bone marrow biopsy needle