骨水泥椎体成形在治疗脊柱转移瘤中的临床应用

Bone cement vertebroplasty for spinal metastasis tumor

中文关键词:  脊柱  肿瘤转移  椎体成形术

英文关键词:Spine  Neoplasm metastasis  Vertebroplasty open surgery.

中文摘要:

  【摘要】 目的：探讨骨水泥椎体成形在脊柱转移瘤治疗中的应用价值。方法：2000年11月～2011年6月我院应用骨水泥椎体成形治疗脊柱转移瘤患者155例，共251个椎体。颈椎1个，胸椎149个，腰椎101个。男性88例，女性67例，平均年龄63.5岁（36~87岁）。采用两种手术方式：应用经皮穿刺椎体成形术或经皮椎体后凸成形术110例，181个椎体；开放性手术椎管减压脊柱内固定，结合术中骨水泥椎体成形或联合其他部位椎体成形45例70个椎体。所有患者术前有严重的腰背痛或合并不同程度的下肢神经功能损害症状。平均VAS评分7.6分（5～10分），术后第３d根据VAS评分评估患者的疼痛缓解情况，术后２周时根据Frankel分级评估神经损害和ECOG评估活动能力的改善。出院后每３个月门诊随访一次，行X线片、CT或MRI检查，每次随访均进行疼痛、神经功能和活动能力的评估。结果：术中无１例出现肺栓塞、截瘫或围手术期死亡，所有患者术后3ｄ内疼痛缓解，平均VAS评分降至2.6分（1～4分），术后２周评估，有神经功能损害者３９例，Ｆｒａｎｋｅｌ分级除2例外均有１级及以上的恢复。ＥＣＯＧ分级４级者１８例，其中１５例改善为３级；３级者92例，其中6３例改善为２级；2级45例中13例改善为1级。椎体成形术中骨水泥的平均注入量为4ml（3~7ml）。108（43%，108/251）个椎体术中出现骨水泥渗漏，19个在椎间隙，86个在椎旁或椎旁静脉，3个椎管内渗漏，但均无临床症状。术后患者均接受化疗和（或）放疗，平均随访20个月（3～36个月），122例死于原发病，33例带瘤存活。结论：对脊柱转移瘤患者选择合适方式的骨水泥椎体成形安全、简单，效果显著，减少了椎体置换或前路开放手术的创伤。

英文摘要:

  【Abstract】 Objective: To evaluate the therapeutic effects of bone cement vertebroplasty for spinal metastasis tumor. Method: A retrospective review(from November 2000 to June 2011) was conducted on 155 consecutive patients(mean age, 63.5 years old), a total of 251 vertebrae were involved. Percutaneous vertebroplasty or surgical decompression combined with posterior instrumentation was performed in 181 vertebrae(110 patients)　and 70 vertebrae(45 patients)　respectively. All patients complained of severe back pain, with or without neurological deficits of lower limbs preoperatively. The patients′ demographic data, visual analog scale(VAS), improvement rate, outcome　and complications were evaluated. Result: The mean preoperative VAS score was 7.6, which decreased dramatically to 2.6 postoperatively(Ｐ＜０．０１). The neurological dysfunction was improved after operation. 2 weeks after operation, all 39 patients except 2 cases suffering from neurological deficit had Frankel scale improved at least 1 level. 18 cases had IV ECOG scale, of these, 15 cases had 3 levels of improvement; 92 cases had III ECOG scale, of these, 63 cases had 2 levels of improvement; 45 cases had II ECOG scale, of these, 13 cases had 1 levels of improvement. The average bone cement volumn infilled was 4ml(range, 3~7ml). Bone cement leakage was noted in 108 vertebrae(43%, 108/251). The mean follow-up was 20 months(range, 3-36 months). 122 patients died of original diseases, while the other 33 remained alive. Conclusion: Vertebroplasty is safe, minimal invasive and reliable which can obviate anterior open surgery.