经皮椎体成形术治疗脊柱转移瘤疼痛的临床研究

Clinical research on the treatment of spinal metastases by percutaneous vertebroplasty

目的探讨DSA引导下经皮椎体成形术（PVP）治疗脊柱转移瘤疼痛的临床疗效。方法 25例患者（男17例,女8例）共36处椎体转移瘤,11处椎体后缘有骨质破坏。在DSA引导下完成经皮椎体成形术（PVP）,术前和术后采用视觉模拟评分（VAS）以及患者服用止疼药的剂量评价疗效,并分析其并发症等术后情况,随访3~12月。采用SPSS 12.0统计软件,采用配对t检验对所得数据进行统计学分析。结果所有患者手术顺利,术后24h VAS平均评分由术前（8.20±0.70）分降至（4.50±0.90）分,术后1月降至（3.20±1.02）分;随访术后3个月VAS评分为（2.50±0.92）分;术后6个月VAS评分为（2.60±0.78）分,术后12个月VAS评分为（2.80±0.96）分,疼痛显著缓解（P〈0.01）。随访发现7例患者停止服用止痛药,13例止痛药用量明显减少,5例维持原剂量。2处椎体发生椎间盘渗漏,6处椎体发生椎旁渗漏,2处椎体发生硬膜外渗漏,但无明显临床症状。结论经皮椎体成形术治疗脊柱转移性肿瘤可获得良好的止痛效果,其创伤小且安全可靠,可以明显提高脊柱转移瘤患者的生存质量。

Objective To discuss the curative effect on the treatment of spinal metastases by percutaneous vertebroplas- ty guided by DSA. Methods 25 patients including 17 males and 8 females, 36 vertebral metastases and 11 cases had bone destruction behind the centrum. Under DSA guidance,PVP was performed in all patients. Visual analogue score（VAS） and effect were evaluated before and after operation. After the procedure, a follow-up for 3-12 months was conducted. The results were sta- tistically analyzed by SPSS 12.0 statistical software. Results The procedure was successfully completed in all patients. Pain rating with VAS before operation and 24 hours after the treatment was 8.20±0.70 and 4.50±0.90 respectively,reduced to 3.20± 1.02 after one month, 2.50±0.92 after the third month,2.60±0.78 after the sixth month,2.80±0.96 after the twelfth month. The difference before and after operation was statistically significant （P〈0.01）. 7 cases completely stopped using analgesic drugs, the number of the analgesic dosage taken by the patients reduced in 13 cases,but unchanged in 5 cases. Bone cement leakage was observed on radiographs in 10 cases, including slight leakage into adjacent disc （n=2）, into paravertebral soft tissues （n=6） and into intracanal epidural space （n=2）, but clinically the patients showed no obvious symptoms. Conclusion For the treatment of spinal metastases, DSA-guided percutaneous vertebroplasty therapy can obtain excellent short-term effect.This treatment is technically minimally-invasive and safe with reliable clinical results, besides,it can markedly improve the living quality of the patients.