微创治疗中脊柱转移瘤椎体成形骨水泥注入及射频消融和放射疗法

Minimally invasive treatments of spinal metastases:vertebroplasty,radiofrequency ablation and radiation therapy

背景:微创技术的发展明显降低了脊柱转移瘤手术并发症,目前微创治疗方法主要有椎体骨水泥增强、射频消融联合椎体成形、术中放疗联合椎体成形3大类。目的:总结上述3大类微创治疗脊柱转移瘤的研究进展。方法:以"脊柱转移瘤,椎体成形,射频消融,放射治疗;spinal metastases,vertebroplasty,radiofrequency ablation,radiotheray"为关键词,检索Pub Med、万方数据库文献。结果与结论:骨水泥增强技术应用广泛、止痛效果很好,有效率达80%-90%,但骨水泥产热杀灭肿瘤的效果非常有限,不能控制肿瘤生长;射频消融及放疗能够杀灭肿瘤,但不能重建稳定性,将不同技术结合可以提高脊柱肿瘤的治疗效果。术中应用放射线、植入放射性粒子或放射性骨水泥是近年发展起来的新技术,因报道较少,缺乏长期随访,目前还不能得出优于单纯骨水泥增强技术的结论。尤其是针对椎体后壁破坏及部分侵入椎管的转移瘤患者,虽然做了很多尝试,但骨水泥渗漏导致神经功能加重的风险依旧很高,所以目前还没有一种完善的微创治疗方法。

BACKGROUND： The development of minimally invasive technology significantly reduces the occurrence of surgical complications due to spinal metastases. Currently, the minimally invasive treatment basically has three broad categories： vertebral cement augmentation, radiofrequency ablation combined with vertebroplasty, intraoperative radiotherapy combined with vertebroplasty. OBJECTIVE： To summarize the research progress of three kinds of minimally invasive treatments for spinal metastases. METHODS： PubMed and Wanfang databases were searched using the keywords of ＂spinal metastases, vertebroplasty, radiofrequency ablation, radiotherapy＂ in English and Chinese, respectively. RESULTS AND CONCLUSION： Vertebral cement augmentation with good analgesic effect has been used widely, and the efficiency is up to 80%-90%. But its effect to kill tumors is very limited that is unable to control tumor growth. Radiofrequency ablation and radiation can kill the tumor, but cannot rebuild the vertebral stability. Therefore, the combination of different technologies can improve the therapeutic effect on spinal tumors. In recent years, intraoperative radiation and implantation of radioactive particles or radioactive bone cement have been developed as new technologies. However, there is no conclusion that these new technologies have better outcomes than the vertebral cement augmentation because of less reports and lack of long-term follow-up. Especially in the metastatic patients with damaged vertebral posterior wall and tumors invaded into vertebral canal, the risk of nerve function damage caused by bone cement leakage is still very high, even after many attempts. Above all, there is no a perfect minimally invasive treatment for spinal metastases.