透视导引下椎体成形术治疗伴有疼痛的转移性椎体肿瘤

Percutaneous vertebroplasy under fluoroscopy guidance in treatment of pain caused by vertebral metastases

背景与目的:椎体转移性肿瘤常引起顽固性疼痛,影响患者的生活质量和治疗信心。本研究评价透视导引下椎体成形术治疗伴有疼痛的椎体转移性肿瘤的疗效和并发症。方法:2002年9月—2007年4月,收住我科的椎体转移性肿瘤患者中选择病例。入选标准:①椎体转移性肿瘤引起腰背部疼痛;②CT示转移病灶以溶骨性改变为主。排除标准:①转移病灶引起神经系统症状;②无法纠正的凝血功能障碍。所有病例均在透视导引下经椎弓根途径进针。结果:共33例患者接受PVP术,其中男性19例,女性14例,年龄32～78岁,中位年龄53岁。共计治疗椎体45个,其中38个行单侧椎弓根注射,7个行双侧椎弓根注射。骨水泥注射量1.5～6.0ml,中位值3.0ml。26个椎体(57.8%)出现骨水泥渗漏,其中14个渗漏至椎旁软组织,8个渗漏入椎旁静脉丛,1个同时渗漏入椎旁软组织和椎旁静脉丛,3个渗漏至椎间隙。术后3d疼痛完全缓解(CR)18例,部分缓解(PR)14例,轻微缓解(MR)1例,有效率97.0%;术后1个月CR17例,PR14例,MR2例,有效率93.9%。14例患者术后有穿刺部位疼痛,酸胀,给予抗炎、抗感染治疗后缓解。结论:透视导引下椎体成形术是治疗伴有疼痛的椎体转移性肿瘤的安全、有效的方法。

Background and purpose：Vertebal metastasis often leads to intractable pain, which may affeet patient＇s quality of life and resuh in associated depression and anxielv. Our research was to study the efficacy and complications of pereulaneous verteln＇oplasty （PVP） under fluoroseopy in the treatment of pain caused by vertebral metastases. Methods： Patients who were admitted in our hospital between Sept. 2002 and Apr. 2007 with the diagn.Ms of vertebral metastasis were atialyzed incclsion criteria were： ①Back pain caused by verlebral metastasis： ②Osteolytic lesion demonstrated by CT scan. Exclusion criteria were： ①Vertebral metastasis invading nervous syslenl; ②Uncontrollable bleeding dialhesis. PVP was performed under fluoroscopy guidance using transpedieulate route iu all patients. Results： PVP was performed in 33 patients aged between 32 -78（ median 53）. Of the 45 vertela＇ae, 38 were treated via unipedieulate approach and 7 via bipediculale approach. The amount of cement injected varied from 1.5 to 6.0 ml （ median vol 3.0 ml）. Cement leakages oc- curred in 26 vertebrae（57.8%）. There were 14 leakages into the periverlebral sol＇l tissue, 8 into the perivertebral venous plexus. 1 in both perivertebral soft tissue and perivertebral venous plexus, and 3 into inter,,ellebral dise. 3 days after procedure, complete relief （CR） of pain was obtained in IS patients, partial relief （PR） in 14 patients, and moderate relief （MR） in I patient, the objeetive effective rate was 97.0%. 1 month after procedure, CR of pain was obtained in 17 patients. PR in 14 patienls, and tnoderate relief （MR） in 2 patients, the objeetive effeclive rate was 93.9v4. Pain at the pulleture site ocetllTed in 14 patients, and was alleviated a（ler symptomatic treatment. Conclusions： Pereutaneous vertebroplasty under fluoroscopy guidance is a safe and efficieut therapy in relieving pain caused by vertebral metastases.