经皮椎体成形术治疗累及椎管的椎体转移性肿瘤

Percutaneous vertebroplasty for metastatic spine disease with spinal canal compression

目的评价经皮椎体成形术(PVP)治疗椎体转移性肿瘤累及椎管的疗效和安全性。方法回顾性分析48例患者,95节椎体PVP治疗的临床及影像学资料。根据MRI矢状位T2W影像将患者分为3组。A组:病变椎体后缘无突出,17例;B组:病变椎体后缘轻度突出,与脊髓未接触,23例;C组:病变椎体后缘严重突出且与脊髓接触,8例。术后1周观察疗效,记录患者疼痛改善情况。结果疼痛总缓解有效率为83.3%(40/48)。A组疼痛缓解有效率94.1%,(16/17);B组有效率82.6%,(19/23);C组有效率62.5%,(5/8)。3组间疼痛缓解有效率差别无统计学意义(P>0.05)。3例患者术后出现根性疼痛加重,B组1例,C组2例,患者服用止痛剂缓解,未手术处理。3组临床并发症发生率分别为0例,1例和2例,3组间并发症发生率差异无统计学意义(P>0.05)。结论PVP是治疗椎体转移性肿瘤的安全有效的方法,临床并发症少,当病变累及椎管甚至脊髓时仍可考虑用该方法治疗。

Objective To evaluate the safety and effectiveness of percutaneous vertebroplasty（PVP）for patients with metastatic vertebral disease and spinal canal compression. Methods A retrospective study was conducted to review 48 consecutive PVP procedures of 95 metastatic vertebral bodies, including 27 men and 21 women, with mean age 63 ± 9 years （ranged 34 - 80 years）. Patients were divided into three groups according to sagittal T2WI manifestation. A group had no spinal canal involvement （n = 17）; B group showed spinal canal involvement but without contact with spinal cord or nerve roots （n = 23）; C group demonstrated contact with spinal cord or nerve root（n = 8）. Procedural safety and clinical efficacy were evaluated at 1 week after the procedure according to WHO standards. Results The total rate of pain relief reached 83.3%（40/48） including remarkable improvement of the pain 94, 1% （ 16/17）in A group; 82.6% （ 19/23 ）and 62.5% （5/8）in B and C group respectively. There were no significant difference in pain relief among the three groups （P 〉 0.05 ）. Three patients appeared with aggravation of radicular pain including one of B group and two in C group. There were no significant differences in the incidence of clinical complications among the three groups （P 〉 0.05 = 0.068）. None of them accepted open surgery except for opioid therapy. Conclusions PVP provides significant pain relief and can be performed safely and effectively in patients with metastatic vertebral disease with and without spinal canal compression or even cord involvement.