DSA导向经皮椎体成形术治疗椎体转移瘤87例疗效分析  

Efficacy analysis of percutaneous vertebroplasty for metastatic vertebral tumors under digital subtraction angiography-guidance in 87patients

作　　者：李岳勇[1] 陆建勋[1] 张倬彬[1] 韦忠恒[1] 蒋天鹏[2] 周石[2] 

机构地区：[1]右江民族医学院附属医院肿瘤介入科,广西百色533000 [2]贵阳医学院附属医院放射介入科,贵州贵阳550004

出　　处：《中华肿瘤防治杂志》2015年第2期143-147,共5页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的探讨数字减影血管造影机(digital subtraction angiography,DSA)引导经皮穿刺椎体成形术(percutaneous vertebroplasty,PVP)治疗椎体转移瘤的技术方法及临床疗效。方法收集2010-10-01-2012-10-01右江民族医学院附属医院收治胸腰椎溶骨性转移瘤患者87例,DSA导向经椎弓根途径穿刺行椎体成形术。病变累及胸椎36例,腰椎51例。术后观察患者视觉模拟疼痛评分(visualana logue pain scale,VAS)变化,行CT扫描观察患者椎体骨水泥填充情况,并经X射线片测量病变椎体前缘高度的变化。结果87例患者96节病变椎体手术均获得成功,手术成功率为100%。骨水泥注射量在腰椎为3~5mL,胸椎2~3mL。出现椎旁骨水泥渗漏3例,椎外静脉渗漏2例,皮下血肿2例,并发症发生率为8.0%(7/87)。术后腰背部疼痛均有不同程度缓解,手术前后疼痛VAS分别为6.5±1.5和2.5±1.5,差异有统计学意义,t=6.23,P<0.01。手术前后摄正侧位片测量椎体前缘高度分别为(15.53±2.23)和(16.37±2.36)mm,差异有统计学意义,P<0.05。所有患者术后1周、1个月和3个月得到随访,脊柱生理曲度正常,无椎体压缩塌陷及脊髓受压、瘫痪等神经系统症状,局部疼痛控制及功能恢复好。结论 DSA引导下PVP治疗胸、腰椎溶骨性恶性肿瘤定位准确,成功率高,并发症少,可有效缓解患者腰背部疼痛,改善了椎体转移瘤患者的生存质量,值得临床推广应用。OBJECTIVE To investiguate the technology method and the therapeutic effects on metastatic vertebral tumors treated by percutaneous vertehro plasty （PVP） under the guidance of the digital subtraction angiography （DSA）. METHODS From October 2010 to October 2012, in Affiliated Hospital of YouJiang Medical College for Nationalites, 87 patients with malignant of osteolytie bone at thoracic and lumbar vertebra body received PVP through the pedicle ap- proach under the guidance the DSA. The malignant tumors involved the thoracic vertebra （36 cases）, lumbar vertebra （51 cases）. After the surgery,changes in the visual analogue pain scale （VAS） and in the CT scanning vertebral body bone cement filling were observed, meanwhile, the changes of the average anterior height of the diseased vertebra were through the X-ray examined. RESULTS Operation was successful in all 96 vertebrae of total 87 patients with a ratio of 100%. The primary volume of bone cement needed to fill lumbar vertebra was 3--5 mL, that for thoracic vertebra was 3--4 mL. Complications including beside the vertebral bone cement leakage （3 cases）,outside the vertebral venous leak- age in 2 cases, subcutaneous hematoma in 2 cases, the incidence of complications was 8.0% （7/87）. to some extent, all patients had the lumbar back pain relieved after the operation; There was a significant statistical difference in the VAS scores between before operation and after operation （t=6.23, P^0.01）, respectively （6.5±1.5）/（2.5±1.5）; There were also significant statistical differences in the average anterior height of the diseased vertebra between before operation and after operation （15.53±2.23） ram/（16.37±2.36） mm through the X-ray examined （P〈0.05）. During the regular follow-up at 1 week,3 and 12 months after PVP, all patients had no vertebral compression collapse, paralysis and compression of the spinal cord and nervous system symptoms, dislocation of cervical vertebra body, spinal cord compression and paralysis, t

关 键 词：数字血管减影机 经皮椎体成形术 椎体转移瘤 视觉模拟疼痛评分 

分 类 号：R738.1[医药卫生—肿瘤]