DSA引导下经皮髋臼成形术治疗髋臼转移性肿瘤的临床研究

DSA-guided percutaneous acetabuloplasty for the treatment of acetabular metastases:a clinical study

目的探讨DSA引导下经皮髋臼成形术(PA)治疗髋臼转移性肿瘤的手术方法、安全性与疗效。方法15例患者共19处髋臼转移瘤,病灶最大径13～25mm,平均(19±4)mm,注入骨水泥5～13ml,平均(8.2±2.3)ml。15例患者均有不同程度髋部疼痛,其中4例能独立行走,但有跛行,8例需要在拐杖帮助下短距离行走,3例完全不能行走。所有患者在DSA引导下行PA,术后随访1～12个月,采用术前、术后视觉模拟评分(VAS)、患者行走功能评分和患者所需服用止疼药的剂量评价疗效,并分析其并发症等情况。并用SPSS12.0统计软件,采用配对t检验和方差分析对所得数据进行统计学分析。结果所有患者手术顺利,术后24hVAS评分由术前平均7.8分降至4.2分,术后1个月降至2.5分;行走功能评分由术前1.5分升至2.5分;14例患者止痛药用量减少,1例患者维持原剂量。3处发生髋臼旁软组织渗漏,3处发生髋臼周围血管渗出,但无明显临床症状。结论DSA引导下PA治疗髋臼转移性肿瘤可获得良好的止痛效果,可以改善行走功能,其创伤小且安全可靠,可以明显提高生存质量。

Objective To discuss the technical points,safety and clinical effectiveness of DSA- guided percutaneous acetabuloplasty（PA）for the treatment of acetabular metastases.Methods Fifteen patients,including 6 males and 9 females,with acetabular malignant metastases were enrolled in this study. A total of 19 lesions were detected.The lesions were 13-25 mm in size（mean 19±4 mm）,the dose of PMMA used for per lesion was 5-13 ml（mean 8.2±2.3 ml）.All patients complained of greater or less degree of pain in their hips,8 patients had to use walking stick,4 patients showed limping although they could walk independently and three patients could not walk alone.DSA-guided percutaneous acetabuloplasty was performed in all patients and follow-up after the procedure was conducted for 1-12 months.Visual analogue score（VAS）,walking state score and analgesic dosage taken by the patients were used for the evaluation of the clinical effectiveness.The complications were analyzed.All the data obtained were statistically analyzed with paired samples t test and analysis of variance by using SPSS12.0 statistical software. Results The procedure was technically successful in all patients.Pain rating evaluated by the VAS decreased from a mean of 7.8 before surgery to a mean of 4.2 in 24 hours after surgery（P〈0.01）,which further decreased to 2.5 in one month（P〈0.01）,while walking state score increased from a mean of 1.5 before surgery to a mean of 2.5 in 24 hours after surgery（P〈0.01）.The analgesic dosage taken by the patient was reduced in 14 patients and remained the same in one patient.The bone cement leakage into para- acetabular soft tissues occurred in three cases and peripheral vascular exudation of acetabulum was observed in three cases with no obvious clinical symptoms.Conclusion As a safe,reliable and minimally-invasive technique,DSA-guided percutaneous acetabuloplasty has excellent anti-pain effect in treating acetabular metastases.This therapy can markedly improve the patient＇s walking ability and the quality of life.