经皮骨水泥髋臼成形术在髋臼溶骨性转移瘤中的临床应用价值

Clinical application value of percutaneous cemented acetabular plasty in the treatment of acetabular osteolytic metastases

目的探讨经皮骨水泥髋臼成形术在髋臼溶骨性转移瘤中的临床应用价值。方法回顾性分析2012年1月~2016年12月我院收治的6例行DSA引导下经皮骨水泥髋臼成形术患者的临床资料,比较手术前后的数字等级量表(NRS)评分和行走功能评分,并计算术后1周、术后1、3个月的疼痛缓解率和行走功能改善率,术后3个月复查CT进行病灶控制情况的评估。结果6例患者均完成髋臼成形术。患者术后1周、术后1、3个月的NRS评分均低于术前,差异有统计学意义(P<0.05);术后1周、术后1、3个月的疼痛缓解率分别为100.0%、83.3%、83.3%。患者术后1周、术后1、3个月的行走功能评分均高于术前,差异有统计学意义(P<0.05);术后1周、术后1、3个月的行走功能改善率分别为83.3%、66.7%、66.7%。术后3个月复查CT,病灶无变化5例(83.3%),进展1例(16.7%)。1例患者术中发生骨水泥渗漏,发生率为16.7%,对髋关节功能无影响,所有患者均未发生骨水泥肺栓塞等严重并发症。结论经皮骨水泥髋臼成形术可有效缓解髋臼溶骨性转移瘤引起的疼痛并改善行走功能,在术后3个月内可维持一个比较稳定的状态,手术并发症发生率较低,是一种安全有效、微创的治疗方法。

Objective To explore the clinical application value of percutaneous cemented acetabular plasty in the treatment of acetabular osteolytic metastases. Methods A retrospective analysis was made of the clinical data of 6 patients who underwent DSA-guided percutaneous cemented acetabular plasty from January 2012 to December 2016. The scores of NRS and walking function before and after operation were compared. The pain relief rate and walking function improvement rate at 1 week, 1 month and 3 months after operation were calculated. The focus control was evaluated by CT at 3 months after operation. Results Acetabuloplasty was performed in all 6 patients. The NRS scores of 1 week, 1 month and 3 months after operation were lower than those before operation, the differences were statistically significant (P<0.05). The pain relief rates were 100.0%, 83.3% and 83.3% in 1 week, 1 month and 3 months after operation, respectively. The walking function scores of 1 week, 1 month and 3 months after operation were higher than those before operation, the differences were statistically significant (P<0.05). The improvement rates of walking function were 83.3%, 66.7% and 66.7% at 1 week, 1 month and 3 months after operation, respectively. Three months after operation, CT showed no change in 5 cases (83.3%) and progress in 1 case (16.7%). The incidence of cement leakage was 16.7%. There was no effect on hip function. No serious complications such as cement pulmonary embolism occurred in all patients. Conclusion Percutaneous cemented acetabular plasty can effectively relieve pain caused by acetabular osteolytic metastases and improve walking function. It can maintain a relatively stable state within 3 months after operation. The incidence of surgical complications is low. It is a safe, effective and minimally invasive treatment.