经皮椎体成形术治疗不同类型疼痛性脊柱转移癌

Percutaneous vertebroplasty for the treatment of painful metastatic spinal lesions of different types

目的评估经皮椎体成形术(PVP)治疗溶骨性、成骨性和混合性疼痛性脊柱转移癌的疗效、并发症及相关技术。方法回顾性分析148例患者148个单椎体接受PVP治疗的椎体转移癌病例。根据病变椎体治疗前的CT表现,将其分为溶骨性(A组)、成骨性(B组)和混合性(C组)椎体转移癌3组。记录各组椎体术中所用透视时间、骨水泥用量及骨水泥渗漏情况。记录各组患者治疗前后的VAS评分。结果 A组86例,B组15例,C组47例患者接受了PVP治疗。A、B、C 3组有效止痛率分别为81.4%(70/86)、80.0%(12/15)和80.9%(38/47),χ2=0.019,P=0.991、P>0.05。3组每个椎体的平均透视时间分别为(8.5±1.9)min、(14.4±2.5)min和(8.3±1.7)min,经方差分析F=63.073、P=0.000;个椎体骨水泥用量分别为(3.36±0.96)ml、(2.60±0.89)ml和(3.23±0.94)ml,F=4.126,P=0.018、P<0.05;骨水泥渗漏率分别为27.9%(24/86)、20.0%(3/15)、25.5%(12/47),χ2=0.435,P=0.804、P>0.05。结论 PVP治疗不同类型椎体转移癌的止痛效果满意,并发症少。但其在成骨性病变的治疗中操作技术相对复杂,需注意穿刺技巧并控制骨水泥用量。

[Abstract] Objective To evaluate the therapeutic efficacy of percutaneous vertebroplasty （PVP） in treating osteolytic, osteoblastic, and mixed painful metastatic spinal lesions, and to discuss its complication and related technique. Methods Single vertebra PVP was carried out in 148 patients with metastatic spinal tumor. The clinical data were retrospective analyzed. According to the preoperative CT manifestations the patients were divided into osteolytic group（n = 86）, osteoblastic group （n = 15） and mixed metastatic group （n = 47）. The fluoroscopic time used for operation, the amount of bone cement used in procedure and the bone cement leakage were recorded. The preoperative and postoperative visual analogue scale（VAS） scores of patients in each group were determined. Results The effective analgesic rate of the osteolytic, osteoblastic and mixed metastatic group was 81.4% （70/86）, 80.0% （ 12/15 ） and 80.9% （38/47）, respectively （X2 = 0.019, P = 0.991, P 〉 0.05）. The average fluoroscopic time of the three groups was （8.5 ± 1.9）min, （14.4 ± 2.5） min and （8.3± 1.7） rain, respectively （F = 63.073, P = 0.000, P 〈 0.05）. The amount of bone cement used in the three groups was （3.36± 0.96） ml, （2.60 ± 0.89） ml and （3.23 ±0.94） ml, respectively （F = 4.126, P = 0.018, P 〈 0.05）. Bone cement leakage rate of the three groups was 27.9% （24/86）, 20.0% （3/ 15） and 25.5%（12/47）, respectively （X2 = 0.435, P = 0.804, P 〉 0.05）. Conclusion For the treatment of painful metastatic spinal lesions of different types, percutaneous vertebroplasty has satisfactory analgesic effect with fewer complications. As the manipulation of PVP in treating osteoblastic metastatic spinal lesions isrelatively complicated, careful attention should be paid to the puncturing skill and the bone cement amount. （J Intervent Radiol, 2014, 23： 122-125）