PVP与PKP术中取材活检对椎体压缩骨折病因诊断的价值

Diagnostic value of vertebral biopsy during percutaneous vertebroplasty or percutaneous kyphoplasty for vertebral compression fractures

中文关键词:  椎体压缩性骨折  活检术  经皮椎体成形术  经皮椎体后凸成形术

英文关键词:Vertebral compression fracture  Biopsy  Percutaneous vertebroplasty  Percutaneous kyphoplasty

中文摘要:

  【摘要】　目的：探讨经皮椎体成形术（PVP）与经皮椎体后凸成形术（PKP）术中取材活检对椎体压缩性骨折病因诊断的价值。方法：2003年1月～2009年12月209例胸腰椎椎体压缩性骨折患者在我院接受PVP或PKP治疗，其中男44例，女165例，年龄36～93岁，平均68岁。24例患者有恶性肿瘤病史，术前诊断为肿瘤性椎体骨折，185例患者术前诊断为骨质疏松性椎体骨折，所有患者术中病椎均取活检样本进行病理学检查。结果：所有患者无一例出现与取活检相关的并发症。183例患者病理结果符合术前骨质疏松性椎体压缩骨折的诊断。24例有恶性肿瘤病史患者中，14例活检结果为椎体转移性肿瘤；10例活检未发现恶性肿瘤成分。2例术前诊断为骨质疏松性椎体压缩骨折患者活检结果1例为多发性骨髓瘤，另1例为椎体转移性低分化腺癌，术前诊断为骨质疏松性椎体压缩性骨折而活检证实为椎体恶性肿瘤的发生率为1.1%（2/185）。结论：PKP与PVP术中取材活检不会增加手术风险，但有助于明确椎体压缩性骨折的病因，应常规进行。

英文摘要:

  【Abstract】　Objective：To discuss the diagnostic value of vertebral biopsy during percutaneous vertebroplasty（PVP） or percutaneous kyphoplasty（PKP） for osteoporotic vertebral compression fractures（OVCFs）.Method：From January 2003 to December 2009，261 vertebral bodies from 209 patients with vertebral compression fractures underwent intraoperative biopsy during either PVP or PKP.There were 165 females and 44 males with the average patient age at surgery of 68 years old（range，36-93 years old）.The diagnosis was osteoporostic vertebral compression fracture in 185 patients，and pathological fracture in 24 patients.All 261 vertebrae had biopsies.Histologic/immunohistochemical tests were performed on each speimens.Result：No surgery related complications were noted in all patients.The biopsy results from 183 patients presumed with OVCFs showed consistence.While for 24 patients having history of malignancy，only 14 showed consistency with their primary diagnosis，and the other 10 patients were determined to have compression fracture despite of their tumor history.2 patients presumed of OVCFs were found malignant，1 multiple myeloma and 1 metastatic carcinoma.The rate of misdiagnose to compression fracture in our study was 1.1%（2/185）.Conclusion：Vertebral body biopsy prior to vertebral augmentation does not increase the risk，on the contrary，it helps to the final pathological identification.As a result，it should be performed routinely.