经皮椎体病变穿刺活检术诊断以及经皮椎体成形术治疗绝经后乳腺癌椎体骨折患者的结果及其安全性的回顾性分析  

The clinical value and safety of pathological diagnosis through percutaneous vertebral biopsy and treatment with percutaneous vertebroplasty in postmenopausal patients with breast cancer and vertebral fracture: A retrospective study

作　　者：宁琳琳[1] 王智煜[2] 李洪涛[2] 郑研[1] 赵晖[2] 姚阳[2] 

机构地区：[1]苏州大学医学部,江苏苏州215000 [2]上海市第六人民医院肿瘤内科,上海200030

出　　处：《肿瘤》2013年第1期58-62,共5页Tumor

基　　金：国家自然科学基金资助项目(编号:81102038;81201628)

摘　　要：目的:探讨数字减影血管造影(digital subtraction angiography,DSA)引导下经皮椎体病变穿刺活检术诊断以及经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗绝经后乳腺癌椎体骨折患者的结果和安全性。方法:对2007年1月-2011年12月接受DSA引导下经皮椎体病变穿刺活检术和经皮椎体成形术的54例绝经后乳腺癌椎体骨折患者进行回顾性分析,这些患者在PVP之前还接受了影像学检查(X线、CT和磁共振)。分别应用视觉模拟评分(visual analogue scale,VAS)、Frankel分级法和活动能力分级法评价PVP治疗前后疼痛、脊髓功能和活动能力的变化。同时,比较经皮椎体病变穿刺活检术与影像学检查的诊断价值。结果:54例患者中,有46例患者通过经皮椎体病变穿刺活检术诊断为乳腺癌椎体转移,49例经影像学检查诊断为乳腺癌椎体转移,其中这2种诊断方法同时确诊的有43例。影像学检查诊断的敏感度为93%。54例患者在PVP治疗后1个月时的疼痛均较治疗前明显缓解(VAS评分分别为2.55±1.55和6.98±1.09分,P<0.05)。8例在PVP治疗前伴有脊髓功能障碍的患者,其中3例由治疗前的Frankel C级恢复至治疗后的Frankel D级,5例由治疗前的Frankel D级恢复至治疗后的Frankel E级。54例患者在PVP治疗后1个月时的活动能力也较治疗前明显改善(P<0.05)。结论:PVP治疗可有效解决乳腺癌椎体骨折患者的脊柱稳定性、病理性骨折以及局部疼痛问题,明显改善患者的生活质量。PVP治疗前进行经皮椎体病变穿刺活检术是对椎体病变作出正确诊断的重要手段,可为临床诊断和治疗提供可靠的证据。Objective： To assess the clinical value and safety of DSA （digital subtraction angiography）- guided percutaneous vertebral biopsy and PVP （percutaneous vertebroplasty） in diagnosis and treatment of vertebral fractures in postmenopausal patients with breast cancer. Methods： A retrospective study was conducted to review the clinical records of 54 postmenopausal patients who had breast cancer and vertebral fractures and received DSA-guided percutaneous vertebral biopsy during PVP between January 2007 and December 2011. The imaging examinations including X-ray, computed tomography scan and magnetic resonance imaging were performed before PVP. The change in pain intensity after PVP was assessed by using VAS （visual analogue scale）. The Frankel grading system and the activity grading system were used to evaluate the changes of spinal cord function and the activity level, respectively. The diagnostic value of DSA-guided percutaneous vertebral biopsy was compared with that of the imaging examination. Results： Of 54 patients, 46 patients were diagnosed as having vertebral metastasis from breast cancer on the basis of the result of DSA-guided percutaneous vertebral biopsy, 49 patientswere diagnosed as having vertebral metastasis from breast cancer on the basis of the result of imaging examination, and 43 patients were diagnosed as having vertebral metastasis from breast cancer by both methods. The diagnostic sensitivity of imaging examination was 93%. Remarkable pain relief was seen in 54 patients one month after PVP （VAS score： 2.55±1.55 vs 6.98±1.09, P 〈 0.05）. Of eight patients with spinal cord injury before PVP, three patients previously with Frankel grade C reached Frankel grade D after PVP, and other five patients previously with Frankel grade D reached Frankel grade E after PVP. The activity level was also improved in all 54 patients one month after PVP. Conclusion： PVP can effectively solve the problems of stability of the spine, pathological fractures of vertebrae and the local pain i

关 键 词：乳腺肿瘤 椎体转移 骨质疏松 活组织检查 椎体成形术 疼痛 

分 类 号：R737.9[医药卫生—肿瘤]