目的:探討單側經椎弓根基底部外側穿刺進針的可行性和安全性。方法:14例椎體壓縮性骨折經椎弓根基底外側穿刺進針,球囊擴張,骨水泥注入治療,使用VAS評分法評價患者疼痛變化,測定手術前后椎體前、中柱高度與Cobb角。結果:單側經椎弓根基底外側穿刺的手術均安全完成。VAS評分由術前平均(8.5±0.3)分改善到術后(2.2±0.2)分,隨訪三月為(2.1±0.4)分 (與術前比較,Plt;0.05); 椎體前緣高度由術前(13.6±2.3) mm到術后(24.5±2.2) mm,隨訪三月為(24.3±2.0) mm(與術前比較,Plt;0.05);錐體中部高度由術前(14.2±2.1) mm到術后(25.6±2.4) mm,隨訪三月為(25.4±2.2) mm(與術前比較,Plt;0.05); Cobb角由術前的(22.5±3.6)°到術后(10.5±3.0)°隨訪三月為(10.3±2.8)°(與術前比較,Plt;0.05)。結論:經椎弓根基底外側的單側穿刺錐體成形術可有效恢復骨質疏松性椎體壓縮性骨折椎體高度、緩解疼痛,是一種安全、有效的治療方法,值得推廣。
Objective To investigate a new surgical approach for presacral lesion by double door via S3- 5. Methods From June 2007 to January 2008, 5 female patients (56-84 years old) with presacral lesion were treated. One patient had straining feel ing in anus, 2 patients had difficult defecation and bloody stool and 2 patients had no symptoms. Digital rectal examination revealed rectal tumor in 2 cases and anus examination of presacral tumor showed no abnormal ity in 3 cases. B-ultrasound, CT and MRI examination displayed presacral tumor in 3 cases and rectumal tumor in 2 cases. The size ofthe lesions was 4 cm × 3 cm × 3 cm - 20 cm × 15 cm × 13 cm. The disease course was 12-50 days (average 18 days). All 5 patients received total resection of tumor through the surgical approach featured by double door via S3-5. Results The operations were successful in all the 5 patients, and no severe presacral venous hemorrhage, rectal injury, direct injury of pelvic nerve and structure damage of pelvic bottom occured during operation. The approach exposure time was 12-28 minutes (average 20 minutes) and the blood loss for approach was 30-130 mL (average 80 mL); and the operation time was 80-120 minutes (average 105 minutes) and the blood loss during operation was 100-350 mL (average 280 mL). All incision healed by first intention. Pathological examination of resected tissue after operation revealed presacral teratoma in 1 case, dermoid cyst in 1 case, spindle cell tumor in 1 case and rectal tubiform villus adenoma in 2 cases. All the patients suffered from perineal hypoesthesia to various degrees after operation, which were recovered to the normal 6 months later, and X-ray films showed bone union occurred in all the cases. No gatism occured. During the followed-up period of 6-13 months, no sacrum defect, pelvic instabil ity and sacroil iitis was observed in the 5 cases. B-ultrasound, CT and MRI examination showed no recurrence of tumor. Conclusion The approach of double door via S3-5 is a simple and safe surgical procedure featured by a good surgical exposure with less bleeding, short operative time, no sacrum defect, no severe sacral nerve damage, and early postoperative convalescence.