经皮穿刺椎体成形术治疗多发性胸椎转移瘤的临床疗效观察

Percutaneous vertebroplasty for multiple thoracic vertebral metastases

中文关键词:  经皮椎体成形术  胸椎  转移瘤  骨水泥

英文关键词:Percutaneous vertebroplasty  Thoracic vertebrae  Neoplasm metastasis  PMMA

中文摘要:

  【摘要】 目的：探讨经皮椎体成形术（ＰＶＰ）治疗多发性胸椎转移瘤的临床疗效。方法：对28例多发性胸椎转移瘤患者的104个椎体在G型臂X线机透视下经皮椎体穿刺并注入聚甲基丙烯酸甲酯（PMMA）骨水泥成形，术后1周、3个月、6个月、12个月时对疼痛缓解程度应用视觉模拟评分法进行评估分级，术后1年时用日常生活自理能力（ADL）量表对治疗后患者生活质量进行评估，同时观察术后病椎椎体形态学变化和椎管内肿瘤的浸润程度。结果：104个椎体穿刺全部成功，1例1个椎体有骨水泥进入相邻椎间盘，无椎管内渗漏和肺栓塞等并发症。PVP后各时间点疼痛缓解率均>80%；术后1年时生活质量评分明显高于术前（P<0．01）。PVP术后1年时椎体前缘、中央、后缘高度与PVP前无差异（P>0．05）；4例患者的5个病椎有椎弓根的浸润并突入椎管内，其余椎体和附件未见肿瘤进一步浸润。结论：经皮穿刺椎体成形术治疗多发性胸椎转移瘤安全可行，具有良好的止痛效果，能够有效改善患者的生活质量，并可显著预防椎体进一步塌陷，同时延缓和降低了椎管内肿瘤浸润的发生。

英文摘要:

  【Abstract】 Objective：To investigate the clinical efficacy of percutaneous vertebroplasty（PVP） for multiple thoracic vertebral metastases.Method：A total of 104 thoracic vertebral from 28 patients suffering from metastases underwent percutaneous vertebroplasty（Polymethyl methacrylate，PMMA） under fluoroscopy.The clinical outcome was self-measured by VAS scale at 1 week，3 months，6 months and 1 year respectively，and by activity of daily life（ADL） system at 1 year，the morphology of revolved vertebral and infiltration of tumor into spinal canal was observed either.Result：All cases underwent surgery successfully，no serious neurological and pulmonary complications relative to PVP except bone cement leakage into adjacent disc.Pain relief beyond 80% was reached at any time point.ADL score of 1 year showed remarkable higher of postoperative than preoperative（P<0.01）.The height of the veterbral body（anterior，median and posterior） showed no significant difference during 12 months of follow-up（P>0.05）.5 thoracic vertebras from 4 patients had the tumor infiltration into pedicle and spinal canal.Conclusion：PVP is a reliable and safe procedure for multiple thoracic vertebral metastases，which is effective in pain relief and improving of life quality as well as preventing of vertebral collapse，it also can delay and reduce the neoplasm infiltration at the same time.