3D打印非共面模板辅助CT引导碘^(125)放射粒子植入联合经皮椎体成形术治疗脊柱转移瘤疗效分析

Efficacy analysis of CT-guided I seed implantation assisted by 3D printing non-coplanar templates combined with percutaneous vertebroplasty in the treatment of spinal metastases

目的探讨3D打印非共面模板辅助CT引导碘^(125)(^(125)I)放射粒子植入联合经皮椎体成形术(PVP)治疗脊柱转移瘤的临床疗效。方法选取辽宁省人民医院自2017年3月至2020年6月收治的22例3D打印非共面模板辅助CT引导^(125)I放射粒子植入联合PVP治疗的脊柱转移瘤患者为研究对象。^(125)I粒子植入流程包括术前模拟定位、术前计划设计、3D模板打印、3D打印非共面模板辅助CT引导下行粒子植入、术后进行CT扫描、剂量验证。术后7~14 d在数字减影血管造影机引导下进行PVP。结果22例脊柱转移瘤患者手术均顺利进行,治疗后临床症状均得到明显改善。术后6个月,患者疾病控制率为95.45%(21/22),客观缓解率为81.82%(18/22)。患者术后的数字疼痛分级法评分为(1.29±0.46)分,显著低于术前的(5.23±0.97)分,差异有统计学意义(P<0.05)。术前Frankel脊髓损伤分级:C级2例,D级15例,E级5例。术后Frankel脊髓损伤分级:D级4例,E级18例。结论3D打印非共面模板辅助CT引导下^(125)I放射粒子植入联合PVP治疗脊柱转移瘤具有治疗精确、创伤小、并发症少的优势,能够缓解患者疼痛,恢复脊柱稳定性,控制肿瘤进展,并提高患者生存质量。

Objective To investigate the efficacy and clinical value of CT-guided^(125)I(^(125)I)seed implantation assisted by three-dimensional(3 D)printing non-coplanar templates combined with percutaneous vertebroplasty(PVP)in the treatment of spinal metastases.Methods A retrospective analysis was performed on 22 patients with spinal metastases who underwent CT-guided^(125)I seed implantation assisted by 3 D printing non-coplanar templates combined with PVP from March 2017 to June 2020.The implantation process of^(125)I seeds included preoperative simulation positioning,preoperative planning design,3 D template printing,CT-guided seed implantation assisted by 3 D printing non-coplanar template,postoperative CT scanning,dose verification,and percutaneous vertebroplasty guided by digital subtraction angiography 7-14 days after surgery.Results All the 22 cases of patients with spinal metastases were performed successfully,and clinical symptoms were significantly improved after treatment.Six months after surgery,the disease control rate(DCR)and objective response rate(ORR)were 95.45%and 81.82%,respectively.Postoperative NRS pain score was(1.29±0.46),significantly lower than that before operation(5.23±0.97),and the difference was statistically significant(P<0.05).Preoperative Frankel grade of spinal cord injury:Grade C in 2 cases,Grade D in 15 cases and Grade E in 5 cases.Postoperative Frankel grade of spinal cord injury:Grade D in 4 cases and Grade E in 18 cases.Conclusion CT-guided^(125)I seed implantation assisted by 3 D printing non-coplanar templates combined with PVP treatment of spinal metastases with precision has the advantage of accurate treatment,slight trauma,less complications,can alleviate patients′pain,restore spinal stability,control tumor progression,and improve the quality of survival.