目的:探讨单侧经椎弓根基底部外侧穿刺进针的可行性和安全性。方法:14例椎体压缩性骨折经椎弓根基底外侧穿刺进针,球囊扩张,骨水泥注入治疗,使用VAS评分法评价患者疼痛变化,测定手术前后椎体前、中柱高度与Cobb角。结果:单侧经椎弓根基底外侧穿刺的手术均安全完成。VAS评分由术前平均(8.5±0.3)分改善到术后(2.2±0.2)分,随访三月为(2.1±0.4)分 (与术前比较,Plt;0.05); 椎体前缘高度由术前(13.6±2.3) mm到术后(24.5±2.2) mm,随访三月为(24.3±2.0) mm(与术前比较,Plt;0.05);锥体中部高度由术前(14.2±2.1) mm到术后(25.6±2.4) mm,随访三月为(25.4±2.2) mm(与术前比较,Plt;0.05); Cobb角由术前的(22.5±3.6)°到术后(10.5±3.0)°随访三月为(10.3±2.8)°(与术前比较,Plt;0.05)。结论:经椎弓根基底外侧的单侧穿刺锥体成形术可有效恢复骨质疏松性椎体压缩性骨折椎体高度、缓解疼痛,是一种安全、有效的治疗方法,值得推广。
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.