【摘要】 背景:目前椎体成形和椎管减压内固定是治疗脊柱转移瘤的常用方法,125I放射性粒子植入控制肿瘤的临床疗效也已得到研究证实,但是关于上述3种方法的综合治疗的临床研究很少。目的:比较采用125 I放射性粒子植入联合椎体成形椎弓根钛合金钉棒内固定与单纯椎体成形椎弓根钛合金钉棒内固定治疗胸腰椎转移瘤在疼痛控制、内固定后体力恢复状态及脊髓神经功能改善等方面的差异,评价125 I放射性粒子植入联合治疗方案的临床应用价值。方法:选择2009年10月至2013年3月于深圳市人民医院脊柱外科手术治疗的胸腰椎转移瘤患者,以脊柱后路胸腰椎钛合金钉棒置入内固定系统,并根据其是否联合125I放射性粒子植入分为实验组与对照组。观察记录各组钛合金钉棒内固定前及内固定后2周,内固定后1,6,12个月的脊髓神经功能改善情况。结果与结论:所有患者均获得随访,随访时间7-29个月,平均15.8个月,脊柱后路胸腰椎钛合金钉棒内固定系统未发生松动断裂,骨水泥分布良好,实验组患者未发现放射性粒子移位及放射性脊髓损伤,随访期内未见病椎局部肿瘤明显复发扩散。实验组患者内固定后目测类比疼痛评分、行为状态评分较对照组明显改善(P<0.05),而2组患者内固定后Frankel分级均分别较内固定前明显改善,2组间神经功能改善情况差异无显著性意义(P>0.05)。说明125I放射性粒子植入联合椎体成形椎弓根钛合金钉棒内固定治疗脊柱转移瘤缓解癌性疼痛的效果更为明显。更多还原

【Abstract】 BACKGROUND: At present, vertebroplasty and spinal canal decompression are common methods for treatment of metastatic spinal tumors. Iodine-125(125I) radioactive seed implantation has been shown to control the tumor. However, there were few clinical studies on combined therapy using above-mentioned methods. OBJECTIVE: To compare the differences of 125 I radioactive seed implantation combined with vertebroplasty and titanium alloy nail-rod fixation and vertebroplasty combined with titanium alloy nail-rod fixation for treating thoracolumbar metastases on pain control, general performance and improvement of the spinal cord function, and to evaluate clinical value of 125 I radioactive seed implantation combined with therapeutic plans. METHODS: Thoracolumbar metastases patients undergoing titanium alloy nail-rod fixation were selected in the Department of Spinal Surgery, Shenzhen Municipal People’s Hospital in China from October 2009 to March 2013. They were assigned to experimental and control groups according to with or without 125 I radioactive seed implantation. Improvement in neurological function was observed before and 2 weeks, 1, 6, and 12 months after titanium alloy nail-rod fixation in both groups. RESULTS AND CONCLUSION: All patients were followed up for 7 to 29 months, averagely 15.8 months. There was no loosening of titanium alloy nail-rod fixation and the position of bone cement was good. No seed migration or radioactive spinal cord injury was observed. No relapse or diffusion in the surgical site was observed duringfollow up. Visual Analogue Scale and Karnofsky Performance Status scores were higher in the experimental group than in the control group(P < 0.05). Frankel level was obviously improved after fixation in both groups compared with preoperation. No significant difference in the improvement of neurological function was detected between the two groups(P > 0.05). Results indicated that 125 I radioactive seed implantation combined with vertebroplasty and titanium alloy nail-rod fixation for treatment of metastatic spinal tumors showed obvious outcomes in relieving cancer pain.更多还原