骨填充网袋辅助经皮椎体成形术治疗伴椎体后壁破损的脊柱转移瘤

Clinical application of percutaneous vertebroplasty assisted by bone filling mesh container for the treatment of spinal metastases complicated by posterior wall destruction of vertebral body

目的探讨经皮椎体成形术(PVP)在骨填充网袋辅助下治疗因转移瘤致椎体后壁破损性骨折的疗效及安全性。方法 31例患者因脊柱转移瘤致椎体后壁破坏而接受骨填充网袋辅助PVP治疗,共43节病变椎体。所有患者原发肿瘤均诊断明确。PVP术前1 d,术后1 d、3 d、1个月、3个月和末次随访采用视觉模拟评分(VAS)评估疼痛程度,Oswestry功能障碍指数(ODI)评估患者运动功能状态。术后记录骨水泥渗漏情况。结果 43节椎体PVP手术成功率100%。术前VAS评分8.2±0.4,术后1 d降至2.5±0.7;术前VAS评分均明显高于术后1 d、3 d、1个月、3个月和末次随访,差异有统计学意义(P均<0.05)。术后ODI均较前明显降低(P均<0.05),患者运动功能状态得到改善。术后影像学(DSA、CT)证实无严重骨水泥渗漏事件发生。结论 PVP在骨填充网袋辅助下治疗因转移瘤致椎体后壁破损性骨折是安全可靠的,并能获得良好的止痛效果及改善患者运动功能状态。

Objective To study the curative effect and safety of percutaneous vertebroplasty （PVP） assisted by bone filling mesh container for the treatment of spinal metastases with vertebral posterior wall destruction. Methods A total of 31 patients with spinal metastasis （43 metastatic vertebrae in total） received PVP with the help of bone filling mesh container. The primary tumors were definitely confirmed in all patients. Visual analogue scale （VAS） was used to evaluate the pain degree at one day before PVP, and at one and 3 days, one and 3 months after PVP as well as at the last follow-up visit. Oswestry dysfunction index （ODI） was adopted to assess patient＇s activity function status. The occurrence of postoperative bone cement leakage was recorded. Results PVP was successfully accomplished for all 43 involved vertebrae, with a technical success rate of 100%. The mean preoperative VAS score was （8.2±0.4） points, which was decreased to （2.5± 0.7） points in one day after PVP. The preoperative VAS scores were higher than all the postoperative VAS scores which were determined at one and 3 days, one and 3 months after PVP as well as at the last follow-up visit, and the differences were statistically significant （P〈0.05 for all）. All postoperative ODI values were significantly lower than corresponding preoperative ones （P〈0.05）. After the treatment, the patient＇s activity function status was obviously improved. Postoperative imaging examination, including DSA and CT, indicated that no serious leakage of bone cement was observed in all patients. Conclusion With the help of bone filling mesh container, the performance of PVP for spinal metastases with vertebral posterior wall destruction is safe and reliable. Clinical satisfactory analgesic effect can be promptly achieved and the patient＇s activity function can be effectively improved.（J Intervent Radiol, 2017, 26： 803-806）