经皮椎体成形术治疗疼痛性成骨性脊柱转移癌

Percutaneous vertebroplasty in treatment of painful osteoblastic metastatic spinal tumors

目的评估经皮椎体成形术(PVP)治疗疼痛性成骨性脊柱转移癌的疗效、并发症及关键技术。方法回顾性分析16例接受PVP治疗的成骨性脊柱转移癌患者(18个椎体),记录术前及术后1天、1周、1个月及3个月的VAS评分,采用可重复检验方差分析比较治疗前后不同时间点的VAS评分,以术后3个月的VAS评分较术前降低≥3分为止痛有效。记录每个椎体术中所用透视时间、骨水泥用量及骨水泥渗漏情况。结果 16例PVP治疗后有效止痛率为81.25%(13/16);术前及术后1天、1周、1个月及3个月的VAS评分分别为:8.4±1.2、3.3±1.6、2.9±1.9、3.0±1.9、3.3±2.0(F=62.221,P<0.001),术后VAS得分较术前明显降低。治疗每个椎体的平均透视时间为(14.2±2.3)min,骨水泥平均用量为(2.67±0.83)ml;骨水泥渗漏率为27.78%(5/18)。结论 PVP治疗成骨性椎体转移癌止痛效果好,并发症少,可作为疼痛性、成骨性椎体转移癌可供选择的治疗方法,但治疗应注意穿刺技巧及骨水泥用量。

Objective To explore the efficacy, complications and key techniques of percutaneous vertebroplasty （PVP） in treatment of painful osteoblastic metastatic spinal tumors. Methods Sixteen patients （18 vertebrae） of osteoblastic meta- static spinal lumors treated with PVP were retrospectively analyzed. Visual analogue scale （VAS） points before PVP, 1 day, 1 week, 1 and 3 months after PVP were recorded and analyzed using repeated measures ANOVA. The analgesic effec- tiveness of PVP was defined when VAS score 3 months post-treatment was lower than 3 points compared with that pre- treatment. Fluoroscopy duration, the amount of bone cement used and the cement leaked during PVP were also recorded. Results The effective analgesic rate was 81.25% （13/16）. VAS score before PVP, 1 day, I week, 1 month and 3 months after PVP was 8.4±1.2, 3.3±1.6, 2.9±1.9, 3.0±1.9 and 3.3±2.0, respectively （F=62. 221, P〈0. 001）. VAS score after PVP decreased significantly compared with that pre-treatment. The average fluoroscopy duration for each verte- bra was （14.2±2.3）min, whereas the amount of bone cement used for each vertebra was （2.67±0.83）ml. Bone cement leakage rate was 27.78% （5/18）. Conclusion PVP may serve as an alternative treatment for painful osteoblastic metastat- ic spinal tumors since its satisfactory analgesic effect and few complications. However, more attention should be paid to puncture skill during the procedure, and the amount of bone cement injected should be chosen with consideration.