影像学引导下经皮骨成形术治疗难治性疼痛性椎体外骨转移瘤

Image-guided percutaneous osteoplasty in treatment of refractory and painful extravertebral bone metastases

目的观察影像学引导下经皮骨成形术(POP)治疗难治性疼痛性椎体外骨转移瘤的效果。方法回顾性分析17例接受POP治疗的难治性疼痛性椎体外骨转移瘤患者,统计POP技术成功率,记录术中骨水泥用量、并发症发生情况,以及术前和术后24 h、1周、1个月、3个月疼痛视觉模拟评分(VAS),评价止痛效果。结果17例中,对6例行DSA引导下POP,11例行CT引导下POP,技术成功率100%(17/17);骨水泥用量1.50~14.00 ml,平均(4.66±3.29)ml。术中12例未见POP相关并发症,5例发生无症状骨水泥渗漏。术前及术后24 h、1周、1个月、3个月时VAS分别为(7.88±0.83)、(2.35±1.45)、(2.18±1.25)、(2.59±1.54)及(3.18±2.00)分,术后各时间点均低于术前(P均<0.05)。术后24 h、1周、1个月及3个月止痛有效率分别为88.24%(15/17)、94.12%(16/17)、76.47%(13/17)及76.47%(13/17)(P=0.467)。结论影像学引导下POP治疗难治性疼痛性椎体外骨转移瘤安全可行,能有效缓解疼痛。

Objective To observe the efficacy of image-guided percutaneous osteoplasty(POP)in treatment of refractory and painful extravertebral bone metastases.Methods Data of 17 patients with refractory and painful extravertebral bone metastatic carcinoma treated with POP were retrospectively analyzed.The successful rate,intraoperative bone cement dosage and complications of POP were counted.Visual analogue scale(VAS)of pain and analgesic effect were evaluated before operation and 24 h,1 week,1 month and 3 months after operation.Results Six patients underwent DSA-guided POP and 11 received CT-guided POP,the technical success rate of POP was 100%(17/17).The amount of bone cement in each patient was 1.50-14.00 ml,with an average of(4.66±3.29)ml.During operation,bone cement leakage(asymptomatic)was observed in 5 patients,while 12 patients occurred no POP-related complications.VAS was(7.88±0.83),(2.35±1.45),(2.18±1.25),(2.59±1.54),(3.18±2.00)scores at pre-operation and 24 h,1 week,1 month,and 3 months after surgery,respectively,lower at each time point after operation than before operation(all P<0.05).The effective rate of pain relief was 88.24%(15/17),94.12%(16/17),76.47%(13/17)and 76.47%(13/17)at 24 h,1 week,1 month and 3 months after POP respectively(P=0.467).Conclusion Image-guided POP was safe and feasible for treatment of refractory and painful external vertebral bone metastases,which could effectively relieve pain.