经皮椎体成形术治疗累及硬膜的脊椎恶性椎体转移性肿瘤  

Percutaneous vosertebroplasty for malignant spinal metastatic tumor with epidural involvement

作　　者：江涛亭 李二生[2] 于华[2] 戈秀波 刘月焜 

机构地区：[1]临西县人民医院导管室,河北邢台054900 [2]邢台医学高等专科学校第一附属医院放射科,河北邢台054001

出　　处：《新乡医学院学报》2015年第9期852-855,共4页Journal of Xinxiang Medical University

摘　　要：目的评估经皮椎体成形术(PVP)治疗累及硬膜的脊椎恶性椎体转移性肿瘤的安全性和临床疗效。方法累及硬膜的脊椎恶性椎体转移性肿瘤患者53例接受PVP治疗。术前按照美国脊髓损伤协会(ASIA)的损伤分级将患者分为2组:A组为无神经压迫症状的患者(n=25),B组为有神经压迫症状的患者(n=28)。2组患者均在X线透视下,用13 G骨穿刺针进入骨折椎体,然后将聚甲基丙烯酸甲酯注入骨折椎体内。术后随访观察2组患者的成功情况、止痛效果、神经功能恢复情况等。结果所有患者均成功接受PVP手术并具有良好的耐受性。最终临床随访评估显示,A组21例患者疼痛得到缓解,4例患者疼痛无变化;B组12例患者疼痛得到缓解,8例患者疼痛无变化,8例疼痛加重;A组患者的疼痛缓解率明显高于B组的疼痛缓解率(84.0%vs 42.9%,P<0.05)。ASIA损伤等级最终评估显示,A组5例表现出神经压迫症状,20例无神经压迫症状;B组26例表现出神经压迫症状,2例无神经压迫症状;A组患者无神经压迫症状比例明显高于B组(P<0.05)。结论 PVP对治疗累及硬膜的脊椎恶性椎体转移性肿瘤是安全的和适度有效的,但PVP不应作为有神经压迫症状的恶性椎体转移性肿瘤患者的一种常规治疗方法。Objective To evaluate the safety and clinical efficacy of percutaneous vertebroplasty（ PVP） on patients with malignant spinal metastatic tumor with epidural involvement. Methods Fifty-three patients with malignant spinal metastatic tumor with epidural involvement were given PVP treatment. Patients were classified into two groups according to impairment classification of American Spinal Injury Association（ ASIA）. There were 25 patients without symptoms of neurological compression in group A and 28 patients with symptoms of neurological compression in group B. 13 G bone puncture needle was placed transpedicularly in the fractured vertebra,and then polymethyl methacrylate（ PMMA） was carefully injected into the fractured vertebral body under continuous fluoroscopic monitoring. Achievement ratio of operation,analgesic effect and neural functional recovery were observed. Results The PVP procedures were technically successful and well-tolerated in all patients.Clinical assessment at the final follow-up found that pain in 21 patients was relieved,in four paitents was unchanged in group A,while pain in 12 patients was relieved,in eight patients was unchanged and in eight patients was aggratated in group B. The pain relief rate in group A was significantly higher than that in group B（ 84. 0% vs 42. 9%,P〈0. 05）. ASIA impairment scale assessment at the final follow-up exhibited that there were five patients with symptoms of neurologic compression and 20 patients with no symptoms of neurologic compression in group A; 26 patients with symptoms of neurologic compression and two patients with no symptoms of neurologic compression in group B. The rate of no symptoms of neurologic compression in group A was higher than that in group B（ P〈0. 05）. Conclusion PVP is a safe and moderately effective procedure for malignant vertebral compression fractures with epidural involvement,but it cann＇t be used as a conventional effective therapy for malignant vertebral compression fractures with symptoms of neurologic

关 键 词：经皮椎体成形术 疼痛 恶性脊椎肿瘤 转移 

分 类 号：R733.3[医药卫生—肿瘤]