经皮椎体成形术治疗颈椎溶骨性骨转移癌的临床观察  

CLINICAL OBSERVATION ABOUT PERCUTANEOUS VERTEBROPLASTY FOR OSTEOLYTIC METASTATIC CARCINOMA OF CERVICAL VERTEBRA

作　　者：张杰[1] 侯梅[2] 费泽军[3] 游昕[4] 李俊[4] 罗勇[4] 廖正银[4] 

机构地区：[1]四川大学华西临床医学院,成都610041 [2]四川大学华西医院胸部肿瘤科 [3]四川大学华西医院放射科 [4]四川大学华西医院腹部肿瘤科

出　　处：《中国修复重建外科杂志》2009年第2期194-197,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的观察经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗颈椎溶骨性骨转移癌并行颈椎功能重建的可行性、安全性及其术式探讨。方法2005年3月-2007年12月,采用PVP治疗颈椎单一椎体溶骨性骨转移癌患者10例。男5例,女5例;年龄38～75岁,平均54.5岁。原发肿瘤:肺癌5例,肾癌、宫颈癌、乳腺癌各1例,原发肿瘤部位不明2例。病程2～4年。椎体转移位于C2 4例,C3、C6、C7各2例,均有明显颈部疼痛及活动受限;术前检查患者一般状况均平稳,无凝血功能障碍、神经根痛或脊髓受压等症状。6例行侧方PVP,经椎动脉与颈动脉鞘间入路;4例行前外侧PVP,经气管及颈内动脉鞘间入路。术中骨水泥填充量为3～4 mL,填充率为50%～100%。结果所有患者穿刺过程均顺利,无明显出血或器官损伤。术中疼痛1例;术后立即行CT或X线检查发现椎旁硬膜外骨水泥渗漏2例,横突孔骨水泥渗漏1例,针道返流3例,均无神经系统受压症状。术后疼痛均有不同程度缓解,术前疼痛视觉模拟评分为(5.9±1.2)分,术后1 h为(2.6±1.2)分,术后1周为(1.6±1.3)分,各时间点两两比较差异均有统计学意义(P<0.05)。于术后1周、6个月和12个月对患者定期随访,所有患者均无椎体滑脱、脊髓受压、瘫痪等神经系统症状出现。3例于术后6个月死亡,2例于术后12个月死亡,死亡原因均为原发肿瘤进展致多器官功能衰竭;余患者颈椎局部疼痛控制且功能恢复良好。结论颈椎PVP止痛快,椎体稳定性恢复满意,并发症轻微;经侧方入路途径安全有效。Objective To investigate the feasibility, safety and operative techniques of percutaneous vertebroplasty （PVP） in treating osteolytic bone metastasis of cervical vertebra and reconstructing the function of cervical vertebra. Methods From March 2005 to December 2007, 10 patients with osteolytic bone metastatic carcinoma in single cervical vertebral body received PVP, including 5 males and 5 females aged 38-75 years （mean 54.5 years）. Among them, 5 patients had primary lung tumor, 1 primary renal tumor, 1 primary breast tumor, 1 primary cervical tumor and 2 unknown primary lesion. The course of disease was 2-4 years. All the patients suffered from obviously cervical pain and limitation of activity, including 4 cases of metastatic tumor of the C2 vertebral body, 2 of C3, 2 of C6 and 2 of C7. The general condition of patients was stable before operation, and no blood coagulation dysfunction, radiculalgia and spinal cord compression were detected. Lateral PVP was performed on 6 cases, approaching between the vertebral artery and the carotid sheath under CT guidance and anterolateral PVP was performed on the rest 4 cases, approaching between the trachea and the internal carotid artery under continuously X-ray fluoroscopy. The amount of bone cement injected was 3-4 mL, and the filling rate was 50%-100%. Results Without obvious bleeding or organ injury, the puncture was performed successfully on all the patients. Without symptom of spinal cord compression, patients suffered from pain during operation （1 case） and such complications noted by immediate CT or X-rays examination after operation as paravertebral epidural cement leakage （2 cases）, transverse foramen cement leakage （1 case） and pinhole reflux （3 cases）. The pain of patients was improved to various degree postoperatively, the visual analogue scales score was （5.9 ± 1.2） points before operation, which was changed to （2.6± 1.2） points at 1 hour after PVP and （1.6 ± 1.3） points at 1 week after PVP, indicating there was a signi

关 键 词：经皮椎体成形术 颈椎 骨转移癌 侧方入路 功能重建 

分 类 号：R738.1[医药卫生—肿瘤]