经皮穿刺椎体成形术治疗多发性胸椎转移瘤

Percutaneous Vertebroplasty for Multiple Thoracic Vertebral Metastases

目的探讨经皮椎体成形术(percutaneous vertebroplasty,PVP)在治疗多发性胸椎转移瘤中的临床应用价值。方法对28例多发性胸椎转移瘤104个椎体在G形臂X线透视下经皮椎体穿刺并注入骨水泥成形,术后疼痛缓解程度应用视觉模拟评分法进行评估分级,采用日常生活自理能力(activity of daily life,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,分别在术后1周、3个月、6个月、12个月进行评价。结果 104个椎体穿刺全部成功,1例1个椎体有造影剂进入相邻椎间盘,无椎管内渗漏和肺栓塞等并发症。PVP后各期疼痛缓解率分别为82.1%(23/28)、89.3%(25/28)、81.5%(22/27)、88.5%(23/26)。根据ADL评分,患者总体生活质量手术前评分(54.3±12.7)分,术后1年提高到(84.3±17.9)分(t=4.562,P=0.008)。PVP后随访椎体前缘、中央、后缘高度与PVP前无统计学差异(P>0.05)。结论 PVP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和椎管内浸润,防止脊髓受压产生神经功能障碍。

Objective To explore the clinical value of percutaneous vertebroplasty（PVP）for patients with multiple thoracic vertebral metastases.Methods Totally 28 patients with multiple thoracic vertebral metastases（104 thoracic vertebral bodies）were enrolled into this study.Under the guidance of G-arm X-ray,we injected bone cement（Polymethyl methacrylate PMMA）into the vertebral bodies.At 1 week,and 3,6,and 12 months after the operation,VAS score and evaluation on activity of daily life（ADL）were employed to determine the surgical outcomes;meanwhile,the morphology of the diseased vertebrae and extent of tumor infiltration were observed.Results The operation was completed successfully in all the 104 vertebrae without complications including intra-vertebral leakage and pulmonary embolism.The rate of pain relief after PVP was 82.1%（23/28）,89.3%（25/28）,81.5%（22/27）,and 88.5%（23/26）at 1 week,and 3,6,and 12 months respectively.ADL evaluation showed that the patients had a significantly high life quality after the operation（54.3±12.7 vs.84.3±17.9,t=4.562,P=0.008）.No significant difference in the anterior central and posterior height of the vertebrae was noticed between pre-and post-PVP.Conclusions PVP is a safe,effective treatment for multiple thoracic vertebral metastases.It is useful to improve patients＇ life quality,and prevent the diseased vertebrae from further deformation and tumor infiltration into the vertebral body,which may cause pressure on the spinal cord leading to neural dysfunction.