经皮椎体成形术联合^(125)I放射粒子植入术治疗椎体转移瘤的效果评价

Effectiveness evaluation on percutaneous vertebroplasty combined with ^(125)I radioactive particle implantation in treatment of vertebral metastasis

目的:探讨经皮椎体成形术(PVP)联合^(125)I放射性粒子植入术治疗椎体转移瘤患者的临床疗效,为治疗椎体转移瘤提供依据。方法:69例椎体转移瘤患者分为试验组(n=32)和对照组(n=37),试验组患者采用PVP联合^(125)I放射性粒子植入术治疗,对照组患者单独采用PVP手术治疗。X射线片检查治疗前后患者椎体前后缘高度;观察并记录患者术前和术后1天、1周、1个月、3个月、6个月的疼痛数字评分(NRS),比较2组患者疼痛缓解率和手术并发症发生率。结果:所有患者手术过程顺利,术后未发现局部出血,未造成运动功能障碍及神经压迫现象。术后次日复查未发现骨水泥外漏现象。所有^(125)I放射性粒子位置良好,未见脱落。治疗后2组患者椎体高度较治疗前升高(P<0.05)。与术前比较,2组患者术后1天、1周、1个月、3个月和6个月NRS评分均明显降低(P<0.05);在术后1周、1个月、3个月、6个月,试验组患者NRS评分低于对照组(P<0.05)。69例患者中肺栓塞或放射性脊髓炎等手术并发症(3例)发生率为4.3%,2组患者手术并发症发生率比较差异无统计学意义(P<0.05)。结论:PVP联合^(125)I粒子植入术治疗椎体转移瘤是一种安全有效的方法,与单独采用PVP手术治疗比较,其可以更明显地缓解患者的疼痛。

Objective:To evaluate the clinical effect of pereutaneous vertbroplasty(PVP).combined with implantation of iodine125(125I)radioactive particle in the treatment of vertebral metastasis,and to provide basis for the treatment of vertebral metastasis.Methods:A total of69patients with vertebral metastasis were divided into test group(n=32)and control group(n=37);the patients in test group were treated with PVP.comined with implantation125I radioactive particle and the patients in control group were treated with PVP only.The heights of anterior and posterior vertebral bodies of the patients before and after treatment were detected by X ray.The numerical rating scale(NRS)scores,pain relief rate and the incidence of surgical.complications of the patients were recorded before operation and1d,1week,1month,3months,and6months after operation.Results:The operation was successfully performed in all the patients without local bleeding;there were no movement dysfunction and nerve.compression phenomenon.There was no leakage of bone cement.All the125I radioactive particles located well and there was no particle obscission.The heights of vertebral bodies of the patients in two groups after operation were increased.compared with before operation(P<0.05).The NRS scores of the patients in two groups s at1d,1week,1month,3months,6months after operation were significantly decreased.compared with before operation(P<0.05);compared with control group,the NRS scores of the patients in test group at1d,1week,1month,3months,6months after operation were decreased(P<0.05).The incidence of pulmonary embolism or radiation myelitis.complications was about43%in69patients..compared with control group,the difference in the incidence of.complications of the patients in test group was not significant(P<0.05).Conclusion:PVP.combined with125I radioactive particle implantation is a safe and effective method in the treatment of vertebral metastasis,which can relieve the pain of the patients obviously.compared with PVP.