骨水泥成形术治疗骨转移瘤的临床观察

Clinical study on bone cementoplasty in bone metastases

目的观察应用微创技术治疗骨转移瘤引起疼痛的效果。方法17例骨转移患者,59处骨转移病灶(55处在椎体,3处在四肢骨,1处在骨盆),其中男性5例,女性12例,年龄30～78岁,平均年龄58.9岁,影像学检查均证实有骨转移瘤(X线片、CT及MRI)。临床伴有明显持续性骨痛,症状持续时间为2～18个月,平均5.7个月。17例患者59处骨转移灶均给予骨水泥成形术治疗。观察治疗前后患者的疼痛强度的变化情况、镇痛药使用评分并行SF-12健康状况调查。结果17例59处病灶手术顺利完成。患者的疼痛评分由治疗前的5.0～9.5(平均7.9±1.2)减少为治疗后的3.1～6.8(平均5.1±1.0)(P<0.01)。患者的止痛药使用评分由治疗前的3～4(平均3.6±0.6),减少为治疗后的1～3(平均2.4±1.1)(P<0.01)。SF-12健康调查评分:治疗前为-17～-33,平均-30.00±4.03,治疗后为-18～-33,平均-26.00±3.94(P<0.05)。术后随访6～17个月,平均12.3个月,患者疼痛均较术前减轻,17例患者中1例在治疗期间出现1个椎体新发的压缩性骨折。结论应用骨水泥成形术治疗骨转移瘤可有效地缓解疼痛,改善患者后期生活质量。

Objective To study the minimal invasive approach and efficacy of bone cementoplasty in bone metastases. Methods Seventeen cases （female 12, male 5 ;aged 30 - 78 years, mean age 58.9） with bone metastases were treated, 59 tumour focus were observed（55 in vertebral body ,4 in non-vertebral body）. All patients were received roentgenographic test, CT scanning and MRI; and all diagnosis were bone metastases with severe and persistent pain. The symptom of pain were sustaining from 2 to 18 months ,average 5.6 months.While 17 cases with 59 tumour focus were operated by bone cementoplasty. The visual analog scale （VAS）, pain killer and SF-12 health survey were compared between before and after treatment phases. Results The therapy was successful in all cases, the severe bone pain was significantly relieved without obvious complication eg. VAS decreased from 5.0 - 9.5 （average 7.9 ± 1.2） to 3.1 - 6.8 （average 5.1 ± 1.0） （P 〈 0.01 ） ;Pain killer decreased from 3 - 4 （average 3.6 ＋ 0.6） to 1 - 3 （average 2.4 ± 1.1 ） （P 〈 0.01 ） and SF-12 increased from -17 - -33 （average -30.00 ± 4.03 ） to -18 - -33 （average -26.00 ± 3.94） （P 〈 0.05）. After following up 6 - 17 months （average 12.3 months）. There was only one case happened one vertebral compress fracture during therapeutic period. Conclusion It is demonstrated that bone cementoplasty treatment for bone metastases can effectively relieve bone pain and improve patient＇s life quality.