组织间^125I放射粒子植入联合经皮椎体成形术治疗胸腰椎转移瘤的价值

Treatment of metastatic thoracolumbar tumors by percutaneous vertebroplasty combined with interstitial implantation of 125I seeds

目的探讨组织间^125I放射粒子植入联合经皮椎体成形术治疗胸腰椎转移瘤的价值。方法对18例胸腰椎转移瘤患者的22节病变椎体进行放射粒子植入术前计划，在CT引导局麻下行^125I放射粒子植入术，术后复查CT，进行质量验证。在数字减影血管造影机器引导局麻下经皮经椎弓根穿刺，将骨水泥注入病变椎体。结果18例胸腰椎转移瘤患者均成功进行了组织间^125I放射粒子植入联合经皮椎体成形术，每节椎体植入放射粒子16～34颗，平均26颗；每节椎体骨水泥的注入量约2～6ml，平均3．5ml。术前和术后2个月患者的数字疼痛分级法疼痛评分分别为（7．12±1．48）分和（2．26±1．07）分，差异有统计学意义（P〈0．05）。15例患者的神经功能较术前改善，3例患者的神经功能较术前无明显变化。结论组织间^125I放射粒子植入联合经皮椎体成形术治疗胸腰椎转移瘤具有创伤小、并发症少、无需外放疗等特点，能有效缓解患者疼痛，限制肿瘤生长，提高患者的生存质量，是一种有前景的治疗胸腰椎转移瘤的微创方法。

Objective To explore the value of percutaneous vertebroplasty combined with interstitial implantation of t25I seeds in the treatment of metastatic thoracolumbar tumors. Methods Based on the CT images before 125I seed implantation, a computer-based treatment planning system （TPS） was used to determine the optimal seed distribution. Under CT guidance and local anaesthesia, 125I seeds were implanted into 22 osseous metastatic lesions in 18 patients. Based on the CT images after the implantation, quality check was carried out with TPS. DSA （digital subtraction angiography）-guided vertebroplasty was performed under local anaesthesia, and bone cement was injected into the vertebrae through pedicle of vertebral arch. Results All the 18 patients received percutaneous vertebroplasty combined with interstitial implantation of 125I seeds. Every vertebra was injected with 2-6 ml bone cement, average 3.5 ml, and was injected with 125I seeds 16-34 pills, average 26 pills. At 2-months follow-up, their numerical rating scale （NRS） pain scores were 7. 12 ± 1.48 before and 2. 26±1.07 after treatment, with a significant difference （ P 〈 0.05 ）. Conclusions Percutaneous vertebroplasty combined with interstitial implantation of 125I seeds is a minimally invasive procedure with small wound and minor complications, and no need of external radiation therapy. It is effective in the alleviation of pain in metastatic thoracolumbar tumor patients, restrains the tumor growth, and improves the quality of life. It is a promising minimally invasive method in the treatment of metastatic thoracolumbar tumors.