经皮穿刺125I放射性粒子联合骨水泥植入病椎治疗脊柱转移瘤的疗效观察

Observation on the therapeutic effect of percutaneous 125I radioactive particles combined with bone cement implantation in the treatment of spinal metastasis

目的:探究经皮穿刺125I放射性粒子植入联合骨水泥填充椎体后凸成形术治疗脊柱转移瘤的临床疗效。方法:回顾性分析2016年1月至2018年1月,65例在我院接受手术治疗的溶骨性脊柱转移瘤患者,其中,行经皮椎体后凸成形术的患者33例(PKP组),经皮穿刺125I放射性粒子植入联合椎体后凸成形术的患者32例(联合组),观察术后1个月、6个月、12个月两组患者骨水泥外渗的相关情况、VAS评分、KPS评分以及术后12个月肿瘤的局部复发率。结果:所有患者随访12~16个月,平均(13±1.5)个月,联合组和PKP组骨水泥外渗百分率分别为21.88%和24.24%,经统计学分析无明显差异。两组骨水泥渗漏的患者均未出现相应临床症状,无需特殊处理。在VAS评分方面,两组术前分别为7.61±0.74和7.55±0.72,术后1个月、6个月、12个月分别降为2.86±0.65、2.21±0.58、2.34±0.68和3.56±0.78、3.42±0.64、3.48±0.69;各组内手术前后比较以及两组间术后比较差异均有统计学意义。在KPS评分方面,两组术前为52±14.3和51±13.2,术后1个月、6个月、12个月分别升为83±12.8、86±14.3、85±14.8和84±11.4、82±14.5、80±15.1,各组内手术前后比较有统计学意义,但两组间术后比较差异无统计学意义。在术后12个月肿瘤复发率方面,两组间比较分别为15.63%和33.33%,具有较为明显的差异性,有统计学意义。结论:经皮穿刺125I放射性粒子植入联合椎体后凸成形术在临床操作上微创、安全,在脊柱转移瘤患者术后身体功能状态治疗效果的稳定性上,可达到单纯行经皮椎体成形术相类似的临床效果,但是其在缓解患者疼痛症状上效果更佳,甚至在肿瘤复发率上,通过远期疗效观察其更在一定程度上优于单纯行经皮椎体后凸成形术。这为脊柱转移瘤患者提供了一种新的有效治疗方法。

Objective:To explore the clinical effect of percutaneous 125 I radioactive seed implantation combined with bone cement kyphosis in the treatment of spinal metastases.Methods:65 patients with osteolytic spinal metastases treated in our hospital from January 2016 to January 2018 were analyzed retrospectively.Among them,33 patients underwent percutaneous kyphosis(PKP group),32 patients with percutaneous 125 I radioactive seed implantation combined with kyphoplasty(combined group).The correlation of bone cement extravasation,VAS score,KPS score and local recurrence rate were observed at 1 month,6 months and 12 months after operation.Results:All patients were followed up for 12 months to 16 months,with an average of(13±1.5)months.In this study,the percentage of bone cement extravasation was 21.88%in the combined group and 24.24%in the PKP group,and there was no significant difference between the two groups.The patients with bone cement leakage in the two groups did not have the corresponding clinical symptoms and did not need special treatment.The VAS scores of the two groups were 7.61±0.74 and 7.55±0.72 before operation,and decreased to 2.86±0.65,2.21±0.58,2.34±0.68 and 3.56±0.78,3.42±0.64 and 3.48±0.69,respectively,in 1 month,6 months and 12 months after operation.There were significant differences before and after operation in each group and between the two groups.The KPS scores of the two groups were 52±14.3 and 51±13.2 before operation,and increased to 83±12.8,86±14.3,85±14.8 and 84±11.4,82±14.5 and 80±15.1 in 1 month,6 months and 12 months after operation,respectively.There was significant difference between the two groups before and after operation.However,there was no significant difference between the two groups.At 12 months after operation,the tumor recurrence rate between the two groups was 15.63%and 33.33%,respectively.Conclusion:Percutaneous 125 I radioactive seed implantation combined with kyphoplasty is safe and feasible in clinical operation and stability in the treatment of postoperative body function in patients with spinal metastasis.It can achieve the similar clinical effect of simple percutaneous vertebroplasty,but it is more effective in relieving the pain symptoms of patients,even in the recurrence rate of tumor.Through the long-term effect observation,it is better than the simple percutaneous kyphoplasty to a certain extent.Therefore,this provides a new and effective treatment for patients with spinal metastases.