经皮椎体成形术及经皮椎体后凸成形术治疗椎体转移瘤的临床应用  

The Clinical Application of Percutaneous Vertebroplasty or Kyphoplasty Percutaneous Treatment for Vertebral Metastases

作　　者：刘启榆[1] 王忠[1] 杨伟[1] 周西[1] 范丹丹[1] 杨勇[1] 罗海燕[1] 

机构地区：[1]四川省绵阳市中心医院放射介入诊疗中心,四川绵阳621000

出　　处：《肿瘤预防与治疗》2014年第1期24-28,共5页Journal of Cancer Control And Treatment

摘　　要：目的:探讨经皮椎体成形术(Percutaneous vertebroplasty PVP)及经皮椎体后凸成形术(Kyphoplasty percutaneous PKP)治疗椎体转移性肿瘤的临床疗效。方法:对38例共44个椎体行PVP,7例9个椎体行PKP,术前VAS标准(visual analog scale,VAS)评分。结果:45例53个椎体手术无死亡病例。术前轻度疼痛4例,中度11例,剧痛31例。术前VAS评分平均为9.2±2.2分。术后3天疼痛完全缓解38例(84.4%);部分缓解5例(11.1%);轻微缓解1例(2.2%);NRl例(2.2%);有效为95.5%,VAS评分2.0±1.4,与术前比较差异有统计学意义(P<0.05);53个椎体术中骨水泥渗漏至椎间盘3例,硬膜外囊2例,椎旁静脉丛1例,椎旁软组织3例;骨水泥外漏发生率16.98%,其中PKP仅发生椎旁软组织外渗1例,术中及术后均无其它并发症发生。PVP式Cobb’s角术前19.3±8.7,术后为18.4±7.8;PKP术前为22.1±8.7,术后为12.2±5.8,术后Cobb’s角与术前比较,PKP术式差异有统计学意义(P<0.01),PVP术式差异无统计学意义(P>0.05);轻度疼痛及中度疼痛完全缓解及部分缓解为100%;重度疼痛完全缓解及部分缓解为93.6%,轻微缓解及无效为6.4%,轻、中、重度各级术后较术前疼痛缓解明显,差异有统计学意义(P<0.05)。结论:PVP及PKP对缓解或消除由椎体转移性肿瘤引起的疼痛有明显的治疗效果,无严重并发症。PKP术对塌陷椎体高度有一定程度恢复。Objective： To investigate percutaneous vertebroplasty （PVP） or percutaneous kyphoplasty （PKP） treat- ment for vertebral metastases. Methods： PVP was performed in 38 patients with 44 vertebrae involvement and PKP was performed in 7 patients with 9 vertebrae involvement. VAS （ visual analog scale, VAS） score was evaluated before opera- tion. Results： No operation-related death occurred in the 45 cases. There were 4 cases with mild pain , 11 moderate pain and 31 severe pain before operation with the average VAS was 9.2 ＋2.2. Complete remission of pain was got in 38 cases （84.4%） ,partial remission in 5 cases（ 11.1% ） ,slight remission in 1 case（2.2% ） and NR in 1 case（2.2% ） 3 days af- ter operation. The effective rate was 95.5% with VAS score was 2.0. -＋ 1.4 which was significantly lower that before oper- ation（ P 〈 0.05 ）. Bone cement leakage occurred in 9 case（ 16.98% ）, including 3 intervertebral leaks , 2 epidural leaks, 1 paravertebral venous plexus and 3 paravertebral soft tissue soft tissue leaks; only 1 paravertebral soft tissue leaks occured after PKP. Cobb＇s angle was 19.3 -＋ 8.7 preoperation and 18.4 ＋ 7.8 postoperation after PVP without significant differ- ence（P 〉 0.05）. It was 22.1 _＋ 8.7 preoperation and 12.2 ＋ 5.8 postoperation in PKP with significant difference（P 〈 0.01 ）. CR and PR of mild pain and moderate pain was 100% ,93.6% of severe pain. MR and NR was 6.4% for severe pain. Pain at different level was statistically relieved after operation（ P 〈 0.05 ）. Conclusion： PVP and PKP could providesignificant pain relief in vertebral metastases; PKP could recover collapsed vertebral body in some degrees.

关 键 词：椎体成形术 经皮椎体后凸成形术 椎体 转移性肿瘤 

分 类 号：R687.3[医药卫生—骨科学]