^125I 放射性粒子植入术联合椎体成形术治疗椎体转移性肿瘤的临床应用研究  

The clinical investigation of radioactive ^125Ⅰ seeds implantation combined with percutaneous vertebroplasty for the treatment of spinal vertebra metastases

作　　者：蔡越飞 钟胜 冼重杨 谭小明 马燕华 

机构地区：[1]广东省东莞市东华医院介入科,523110

出　　处：《中国医师进修杂志》2013年第8期33-36,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的评价 ^125Ⅰ 放射性粒子植入术联合椎体成形术治疗椎体转移性肿瘤的临床疗效。方法15例骨转移瘤患者共21个病灶，根据CT图像应用计算机治疗计划系统（TPS）制定粒子植入计划，按计划在CT引导下进行 ^125Ⅰ 放射性粒子植入治疗。术后将x线片和CT扫描图像输入治疗计划系统进行质量验证。观察术后疼痛缓解情况和局部病灶的影像学变化。2个月后，行椎体成形术，骨水泥按甲基丙烯酸树脂多聚体／液态甲基丙烯酸树脂单体／造影剂3：2：1比例配制。胸腰骶椎区均采用经椎弓根或椎体后外侧穿刺，在确定穿刺到位并无椎管内渗漏后，将骨水泥快速灌注至椎体内。结果。^125Ⅰ 放射性粒子植入术联合椎体成形术治疗骨转移瘤，其中8例为显效，6例为有效，1例为无效。治疗后疼痛分级明显降低。术后2个月CT复查显示，21个转移病灶中，局部控制7个，无变化12个，进展2个，病变控制率为90．5％（19／21）。所有患者均未出现严重并发症。结论 ^125Ⅰ 放射性粒子植入术治疗椎体转移性肿瘤止痛效果好，不良反应发生率低且程度轻，是一种疗效较好的治疗方法。椎体成形术能够强化靶区硬度，且止痛效果迅速。^125Ⅰ 放射性粒子植入术联合椎体成形术可以优势互补。Objective To study and evaluate the therapeutic efficacy of CT-guided radioactive ^125Ⅰ seeds implantation combined with percutaneous vertebroplasty for spinal vertebra metastases. Methods Fifteen patients and 21 lesions were enrolled in this study. Based on the CT images, a computer-based treatment planning system （TPS） was used to determine the optimal seeds distribution. Under CT-guided, radioactive ^125Ⅰ seeds were implanted into the lesions. Based on the X-ray and CT image after the implantation, quality cheek was carried out with TPS. The ostalgia-relieving degree and the image alterations of the spinal vertebra metastases lesions were observed. Two months later, 15 patients underwent percutaneous vertebroplasty with DSA guidance, bone cement was made according to the ratio methyl acrylic resin polymer/liquid methyl acrylic resin monomer/contrast as 3 ： 2 ： 1 in injecting paste form. The puncturation through pedicle of vertebral arch and lateral posterior body of vertebra was both adopted in thoracic and lumbosacral vertebrae site. After making sure that the puncturation was completed and there was no leakage in vertebral body, the bone cement was injected into vertebral body quickly. Results Accepted radioactive ^125Ⅰ seeds plantation,relief of pain was obtained. Among 15 patients, 8 patients were powerful, 6 patients were effective and 1 patient was inefficiency. After treatment, the pain grading significantly decreased. After treatment for 2 months, CT was used to recheck, 7 lesions were local controlled, 12 lesions had no changes, 2 lesions were progress. The responsive rate was 90.5% （19/21）. No serious side-effect happened. Conclusions Radioactive ^125Ⅰ seeds implantation can be a safe and effective method in treating spinal vertebra metastases and obtaining good clinical effects with minimal damage and few complications. Percutaneons vertebroplasty can strengthen the target and relief pain quickly. CT-guided radioactive ^125Ⅰ seeds implantation combined with percutaneous vertebr

关 键 词：碘放射性同位素 椎体转移瘤 椎体成形术 

分 类 号：R687.3[医药卫生—骨科学]