经皮椎体成形术治疗颈椎转移瘤

Percutaneous vertebroplasty for metastatic lesions of the cervical spine

目的评估经皮椎体成形术(PVP)3种路径治疗颈椎溶骨性转移瘤的疗效和安全性方法回顾性分析36例(57节椎体)经PVP治疗颈椎溶骨性转移瘤患者的临床资料。采用WHO标准和视觉模拟评分(VAS)评价患者临床疗效,并分析总结不同部位椎体3种手术入路的应用经验。结果3组穿刺路径分别是前外侧入路、侧方入路、经椎间盘入路。所有椎体穿刺和骨水泥注射技术成功率达100%。术后随访至少3个月,资料完整的32例患者中11例完全缓解(CR),20例部分缓解(PR)、1例术后轻度缓解(MR),0例无效(NR),临床治疗有效率(CR+PR)达96.87%。患者术前、术后24 h、1周和3个月的VAS评分差异有统计学意义(P<0.05)。17节椎体发生少量骨水泥渗漏(29.82%),但均无严重并发症。结论前外侧入路PVP治疗C4～C7溶骨性转移瘤方便安全、有效。侧方入路治疗Cl,经椎间盘入路治疗C2、C3椎体转移瘤亦安全可行。临床应根据具体情况合理选择手术入路。

Objective To assess the safety and effectiveness of percutaneous vertebroplasty （PVP） performed via three different routes for the treatment of osteolytic metastatic lesions of the cervical spine. Methods A total of 36 patients with osteolytic cervical metastases （57 cervical vertebrae involved） received the treatment of the PVP. The clinical data were retrospectively analyzed. The WHO standards and visual analogue scale （VAS） were assessed before and after the operation, and the application of three operative accesses （anterolateral approach, lateral approach and anterolateral approach through disc space） was discussed. Results The puncturing accesses used in three groups were anterolateral approach, lateral approach and anterolateral approach through disc space. The whole procedure, including puncturing and injection of bone cement, was successfully accomplished for all diseased cervical vertebral bodies. All patients were followed up for three months. Of 32 patients who had complete clinical data, complete remission （CR） was obtained in 11, partial remission （PR） in 20, mild remission （MR） in one and no remission （NR） in zero. The clinical effectiveness （CR ＋ PR） was 97%. The VAS scores before operation as well as 24 hours, one week and 3 months after the operation were separately determined, and four groups of data were obtained. Statistically significant difference in VAS scores existed between each other of the above four data groups （P 〈 0.05）. A little bone cement leakage was observed in 17 vertebral bodies （29.82%）, however, no serious clinical complications occurred. Conclusion Percutaneous vertebroplasty via anterolateral approach is a safe and effective technique for the treatment of osteolytic metastases located at lower cervical vertebrae （C4-C7）. While in treating metastatic lesions invaded the vertebra of C1, PVP via lateral approach should be employed. For C2 and C3 vertebral involvement, PVP via anterolateral approach through disc space should be adopted. In clinical practice, the operative approach should be reasonably selected according to the specific circumstances.