摘要
目的探讨经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗胸腰椎体转移瘤的临床疗效及安全性。方法在C臂X线机透视下采用经皮单侧椎弓根穿刺注入PMMA(聚甲基丙烯酸甲酯)于受累椎体内进行止痛治疗,同时进行肿瘤个体化的综合治疗以及抗骨质疏松治疗。共22例26个受累椎体,其中胸椎11例,腰椎8例,胸腰椎两个椎体受累共有2例,胸腰椎3个椎体受累1例。所有患者均有不同程度的骨质疏松症及较重难以忍受的腰背部疼痛,2例有轻度神经根症状。对治疗后1周,3月,6月,12月患者疼痛程度采用视觉模拟评分法(visual-analogue-scale-scores,VAS)进行评估,观察对比手术前后活动能力、生活自理能力的变化及病椎的形态学变化和骨密度变化,评价治疗效果。结果本组26个椎体全部穿刺成功,骨水泥渗透4例,椎间盘及椎体前缘渗漏3例,椎管内渗漏1例,未出现神经根症状。患者PVP手术后1周,3月,6月,12月各时间点VAS评分疼痛缓解率均大于80%,活动能力和生活质量评分也明显改善,随访12个月内生存患者有19例,胸腰椎疼痛未见加重,病椎高度未见明显压缩,亦未见肿瘤浸润加重。骨质疏松程度未见加重,5例由OP好转为骨量减少。结论 PVP治疗胸腰椎体转移瘤具有对患者机体干扰小,止痛效果显著,手术简单,相对安全,可以预防病椎的进一步骨折和塌陷,提高患者生活质量等优点,疗效满意,是综合治疗胸腰椎转移瘤的一种有效补充。
Objective To study the clinical efficacy and safety of percutaneous vertebroplasty （PVP） in the treatment of metastatic turmors in the lumbar and thoracic spine. Methods Twenty-six vertebral bodies of 22 patients underwent percutaneous injections of surgical bone cement （polymethyl methacrylate, PMMA） under X-ray guidance, including 11 thoracic vertebrae, $ lumbar vertebrae, 2 cases of 2 combined vertebrae, and 1 case of combined vertebrae. All the patients suffered from certain degree of osteoporosis with severe or untolerant back pain, and 2 patients had light nerve root syndrome. The patients were evaluated using visual- analogue scale （VAS） on 1 week, 3 and 6 months after the treatment. Mobility, self- restraint ability, and morphometry of the diseased vertebrae of the patients were examined on 12 months after the surgery and the efficacy was evaluated. Results Successful acupuncture was achieved in all 26 vertebral bodies. Bone cement leakage occurred in 4 cases, including 3 leakages in the disc or anterior of the the vertebrae, and 1 leakage in the vertebral canal. No neurological symptoms occurred. VAS score and effective pain relief rate were all above 80% at the time points of 1 week, 3-, 6- and 12-month after PVP operation. Scores of mobility and quality of life improved significantly. Nineteen patients survived during the 12-month follow up period. The back pain did not increase. The height of the vertebral body did not shorten. No increase of the turmor metastasis was found. Conclusion PVP for the treatment of metastatic turmors in the lumbar and thoracic spine provides less injury, obvious sedative effect, simple operation, relatively safeprocedure. It prevents diseased vertebrae from further fracture and compression, resulting in improved quality of life with satisfactory efficacy.
出处
《中国骨质疏松杂志》
CAS
CSCD
2011年第5期400-404,共5页
Chinese Journal of Osteoporosis
基金
珠海市医学重点建设专科基金资助项目(珠卫2008[80])
关键词
椎体转移瘤
骨质疏松
经皮椎体成形术
疼痛
Vertebral body metastatic tumor
Percutaneous vertebroplasty
Pain
