Percutaneous vertebroplasty for thoracic vertebral metastases  

作　　者：李健[1] 黄海[1] 潘永谦[1] 张平[1] 杨波[1] 莫世奋[1] 

机构地区：[1]广州医学院第三附属医院骨外科,广州510150

出　　处：《中国矫形外科杂志》2011年第11期912-917,共6页Orthopedic Journal of China

摘　　要：[背景]脊柱转移瘤是最常见的骨转移瘤,高达40%的癌症患者发生脊柱转移[1]。脊柱转移瘤常常引起椎体骨折、脊柱不稳、脊髓及神经根压迫等及其他合并症。手术治疗的目的在恢复脊柱稳定性的同时解除神经压迫的因素。[方法]从2003年1月～2009年7月,21例胸椎转移瘤患者(女12例,男9例;平均年龄58.3岁)行经皮穿刺椎体成形术PVP(percutaneous vertebroplasty)治疗,并对患者术前、术后(1周、6个月及1年)进行随访调查,通过视觉模拟评分法(VAS)、日常生活自理能力(ADL)量表进行评价。[结果]21例手术均成功,椎体成形术中平均每个椎体骨水泥(PMMA)注射量约(2.9±0.3)ml(1.7～4.1 ml)。大部分患者94%(19/21)、88.2%(15/17)、100%(14/14)术后短期及长期均有良好的治疗止痛效果,术前VAS平均8.38±0.653降至术后1年随访内平均2.69±1.75。根据ADL评分,大部分患者无伴疼痛或伴轻微疼痛,其总体生活质量均有所提高。[结论]经皮穿刺椎体成形术(PVP)是缓解胸椎转移瘤引起顽固性疼痛一种安全、有效、简单的治疗手段。其通过增加椎体强度、提高脊椎的稳定性防止病椎塌陷引起的脊髓受压产生的神经功能障碍,同时降低了椎管内肿瘤的浸润。PVP可能成为缓解椎体转移瘤导致疼痛的一种治疗手段。[ Objectives ] The spine is the most common site of skeletal metastases with its involvement occurring in up to 40% of patients . Spinal metastases often cause vertebral fractures, spinal instability, spinal cord and nerve root compression and other complications. The goal of surgery is to achieve circumferential decom- pression of the neural elements while reconstructing and immediately stabilizing the spinal column. [ Methods ] From January 2003 to June 2009, 21 patients of thoracic spinal metastases （12 women and 9 men, mean age 58.3 years ） were treated by PVP. Follow - up analysis was made through a questionnaire completed by Pain Visual Analog Scale （ VAS）, the quality of life of these patients were also analysed by the activities of daily living （ADL） preoperatively and postoperatively （1 week, 6 months, 1 year ） [ Results ] All the 21 surgeries were successful. The average amount of polymethylmethacrylate （PMMA） cement introduced per -vertebra was 2.9 ± 0.3 ml （range, 1.7 -4. 1 ml） in PVP .The majority of individuals 94% （19/21） 88.2% （15/17） 100% （14/14） reported short- and long- term symptomatic improvements, and the mean VAS decreased significantly from 8.38 ± 0. 653 presurgery to 2. 69 ± 1.75 postsurgery during the 1 - year of follow - up. According to ADL score, most patients with no pain or mild pain unaccompanied, overall quality of life were improved. [Conclusion] Percutaneous vertebroplasty （PVP） is a safe, effective, and simple treatment for the management of intractable pain due to metastases. It reinforces the strength of the vertebral body, improves the spinal stability to prevent diseased vertebrae from further collapse, which may cause pressure on the spinal cord leading to neural dysfunction, and reduce the neoplasm infiltration at the same time. It is possible for percutaneous vertebroplasty to be as the first line treatment option for pain control in vertebral metastases.

关 键 词：椎体成形术 胸椎转移瘤 疼痛 骨水泥 

分 类 号：R687.3[医药卫生—骨科学]