经后路内固定结合^(125)I置入治疗脊柱转移瘤

Posterior internal-fixation combined with iodine-125 interstitial brachytherapy in the treatment of spinal metastastic tumors

目的:探讨经后路内固定结合放射性粒子125I置入近距离照射治疗脊柱转移瘤的近期效果。方法:2004年7月～2008年3月收治17例脊柱转移肿瘤致脊柱不稳伴顽固性腰背部疼痛或神经根性疼痛不宜行肿瘤切除的患者,先经后路脊柱内固定系统重建脊柱稳定性,再在C型臂X线机监视下置入125I粒子近距离照射。随访观察治疗效果。结果:随访7～39个月,平均21.3个月。术后3～26d起效,12例疼痛缓解(VAS评分<20mm),3例减轻(VAS评分20～40mm),2例无改善。11例有神经功能损害的患者8例明显改善,2例无改善,1例加重。2例分别于术后7个月、8个月死于肝脏衰竭,1例于术后15个月死于多器官衰竭,其余14例患者末次随访时仍存活,5例复查肿瘤生长得到抑制,无再发椎体转移。结论:对于转移瘤致脊柱不稳定,有顽固性疼痛又不宜行肿瘤切除者,经后路椎弓根钉系统重建脊柱稳定性同时置入放射性粒子近距离照射治疗可以缓解疼痛、延缓肿瘤生长,同时避免脊柱的稳定性丧失。

Objective ：To evaluate the preliminary results of posterior internal-fixation combined with iodine- 125 （^125I） interstitial braehytherapy in the treatment of spinal metastatic tumors.Method：From July 2004 to March 2008,17 cases with spinal metastatic tumors who had spinal instability and intractable back pain or nerve root pain and were not suitable for tumor resection underwent ^125I seeds implantation under the guidance of C-arm fluoroscopy after posterior internal-fixation to reconstruct the spinal stability.Result：The time of follow-up was 7-39 months averaged 21.3 months.The effect was revealed 3-26 days after the operation.12 cases had complete pain relief（VAS scores 〈20mm）,3 cases had partial pain relief（VAS scores were between 20-40mm）.2 cases had no pain relief（VAS scores 〉40mm）.8 of 11 cases who presented neurological dysfunction showed a good recovery,but 2 cases had no change at all and 1 case became wrose.2 cases died of hepatic failure at 7th and 8th months respectively after operation.One case died of multiple organs failure （MOF） 15 months later.The other 14 cases were alive at the final follow-up.The tumor growth was restrained and no recurrence of vertebral metastasis was found in 5 cases.Conclusion：Posterior internal-fixation for reconstruction of spinal stability combined with ^125I interstitial brachytherapy is a good alternative for the treatment of spinal metastatic tumors which lead to spinal instability and intractable pain,or are unresectable.It can relieve pain,restrain the growth of tumor,and avoid losing spinal stability.