【作者】 徐宝山； 胡永成； 唐天驷； 倪才方； 周静； 王林森； 徐瑾；

【Author】 XU Baoshan HU Yongcheng TANG Tiansi et al Department of Orthopaedic Oncology, Tianjin Hospital, Tianjin 300211XU Baoshan

【机构】 天津医院； 苏州大学附属第一医院；

【摘要】 目的:探讨经皮椎体成形术(percutaneous vertebroplasty,PVP)对脊柱溶骨性肿瘤的治疗价值。方法:40例脊柱溶骨性转移瘤和骨髓瘤患者均有背部疼痛症状,其中6例有神经根损伤症状,1例有截痪,CT或MRI示脊椎溶骨性破坏,21例有椎体后壁骨折或破坏,其中9例有硬膜外肿块;行PVP治疗42次共59个椎体,包括颈椎1处,胸椎29处,腰椎27处,骶椎2处,54个椎体单侧注射,5个椎体双侧注射,每椎注射3～11ml,平均6.5ml,28例同时取活检;术后行CT检查,并结合行放疗、化疗等药物治疗。结果:39例术后在4～72h内均感到疼痛缓解,38例活动状况改善,术前有神经根损伤和截瘫者神经功能均无明显变化;2例脊柱多发严重破坏者行单处PVP后1例疼痛无缓解,1例疼痛缓解48h后又复发,活动状况均无明显改善;术后CT示17例23椎存在灌注剂渗漏:6例7椎有椎管内少量渗漏,2例2椎有椎间孔内少量渗漏,6例8椎有椎旁渗漏,5例6椎有椎间盘内渗漏,2例硬膜外渗漏引起暂时性神经根症状加重,保守治疗后好转,其他渗漏均未引起临床症状;术后37例随访1～24个月(平均6.5个月),除2例术后无效外,其他35例均自觉疼痛缓解,其中29例疗效稳定,6例疼痛缓解几个月后又加重,考虑与病变进展有关。结论:PVP作为治疗脊柱溶骨性肿瘤的微创技术,能立即缓解疼痛,改善活动状况,并可与放疗、化疗等常规措施结合应用。更多还原

【Abstract】 Objective: To analyze the clinical results of percutaneous vertebroplasty (PVP) for osteolytic spine tumor. Methods: Forty patients with osteolytic vertebral metastases or myeloma complained of back pain, and 6 cases had radiculopathy,1 cases had paralysis. On CT or MRI scan destruction of the posterior vertebral wall was detected in 21 cases,and epidural neoplasm was present in 9 cases.Forty-two PVP was performed at 59 segment levels with fluoroscopic or CT guidance: one at cervical level, 29 at thoracic level,27 at lumbar level,2 at sacrum, and biopsy was performed in 28 cases at one session. A CT scan was obtained after intervention to assess the lesion filling and cement leakage,and all patients was asked to remain flat for 4 hours prior to axial loading. In combination with PVP,radiotherapy,chemotherapy and medication were given before or after intervention. Results: The procedure was technically successful in all patients with an average injection amount of 6.5ml cement per vertebral body. Partial or complete pain relief was achieved in 39 patients associated with improved mobility in 38 cases,and radiculopathy and paralysis were unchanged. Two patients with multiple and severe vertebrae destruction underwent PVP at one segment level,none of them experienced improved mobility, in one patient, the amount of pain was unchanged, the other one experienced partial pain relief for 48h. Leaks were detected with CT in 23 levels of 17 patients. Two of 7 epidural leaks produced transitory radicular pain which resolved in 8 and 6 hours respectively, The 2 foramina venous leaks, 8 par-avertebral leaks, and 6 intradiskal leaks had no clinical importance. Thirty-seven patients were followed up from 1 to 24 months (average,6.5months),except poor results in two patients, pain relief were sustained in 29 cases,and six patients experienced relapse of pain following partial pain relief,which was related to theObjective: To analyze the clinical results of percutaneous vertebroplasty (PVP) for osteolytic spine tumor. Methods: Forty patients with osteolytic vertebral metastases or myeloma complained of back pain, and 6 cases had radiculopathy,1 cases had paralysis. On CT or MRI scan destruction of the posterior vertebral wall was detected in 21 cases,and epidural neoplasm was present in 9 cases.Forty-two PVP was performed at 59 segment levels with fluoroscopic or CT guidance: one at cervical level, 29 at thoracic level,27 at lumbar level,2 at sacrum, and biopsy was performed in 28 cases at one session. A CT scan was obtained after intervention to assess the lesion filling and cement leakage,and all patients was asked to remain flat for 4 hours prior to axial loading. In combination with PVP,radiotherapy,chemotherapy and medication were given before or after intervention. Results: The procedure was technically successful in all patients with an average injection amount of 6.5ml cement per vertebral body. Partial or complete pain relief was achieved in 39 patients associated with improved mobility in 38 cases,and radiculopathy and paralysis were unchanged. Two patients with multiple and severe vertebrae destruction underwent PVP at one segment level,none of them experienced improved mobility, in one patient, the amount of pain was unchanged, the other one experienced partial pain relief for 48h. Leaks were detected with CT in 23 levels of 17 patients. Two of 7 epidural leaks produced transitory radicular pain which resolved in 8 and 6 hours respectively, The 2 foramina venous leaks, 8 par-avertebral leaks, and 6 intradiskal leaks had no clinical importance. Thirty-seven patients were followed up from 1 to 24 months (average,6.5months),except poor results in two patients, pain relief were sustained in 29 cases,and six patients experienced relapse of pain following partial pain relief,which was related to the deterioration of tumors. Conclusion: PVP of osteolytic spine tumors is a minimal invasive procedure that provide immediate and long-term pain relief with improved mobility, which can be combined with radiotherapy or chemotherapy.deteri更多还原