经皮椎体成形术联合^(125)I粒子组织间置入术治疗伴后缘破坏的椎体转移瘤  

Percutaneous vertebroplasty combined with interstitial implantation of ^(125)I seeds for the treatment of spinal metastases with destroyed posterior margin of the vertebral body

作　　者：肖全平[1] 魏乐群 牛焕章[1] XIAO Quanping;WEI Lequn;NIU Huanzhang(Department of Interventional Radiology,First Afiliated Hospital of Henan University of Science and Technology,Luoyang,Henan Province 471000,China)

机构地区：[1]河南科技大学第一附属医院介入科,471000

出　　处：《介入放射学杂志》2023年第9期866-870,共5页Journal of Interventional Radiology

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20190565)。

摘　　要：目的探讨经皮椎体成形术(percutaneous vertebroplasty,PVP)联合^(125)I粒子组织间置入术治疗伴后缘破坏的椎体转移瘤的安全性和有效性。方法回顾性分析2019年6月至2021年6月在河南科技大学第一附属医院介入科接受治疗的55例患者75节病变椎体。采用随机数字化法将患者分为两组,25例患者40节病变椎体接受PVP联合^(125)I粒子组织间置入术(联合组),30例患者35节病变椎体接受PVP(单一组)。使用视觉模拟量表(visual analogue scale,VAS)、卡氏评分(Karnofsky performance score,KPS)评估疼痛程度及体力状况。CT评估骨水泥分布及渗漏,MRI评估肿瘤控制情况,记录两组骨水泥数量及^(125)I粒子数目,Kaplan-Meier法分析两组患者生存情况。结果手术成功率是100%,联合组VAS评分由术前(8.25±0.31)分降至术后12个月(3.27±0.83)分,单一组VAS评分由术前(8.53±0.21)分降至术后12个月(3.98±0.69)分,联合组与单一组术后1、3、6、12个月VAS评分比较差异均有统计学意义(均P<0.05)。联合组KPS由(43.46±9.66)分升至术后12个月(90.05±2.06)分,单一组KPS由(41.15±8.36)分升至术后12个月(84.05±1.56)分。联合组与单一组术后1个月KPS差异无统计学意义(P=0.983),术后3、6、12个月KPS比较差异有统计学意义(均P<0.05)。联合组每个椎体骨水泥注射量为(2.8±0.6)mL,粒子植入量为(15±2)粒,单一组骨水泥注射量为(3.1±0.3)mL。联合组和单一组骨水泥渗漏发生率为42.5%和53.5%,单一组骨水泥漏入椎管1例,无相应症状发生。术后随访联合组肿瘤控制有效率与单一组比较差异有统计学意义(均P<0.05)。两组生存方面差异无统计学意义(P=0.324)。结论PVP联合^(125)I粒子组织间置入术治疗伴后缘破坏的椎体转移瘤安全可靠,较单纯PVP更能明显缓解疼痛、控制肿瘤生长。在延长生存时间方面无明显区别。Objective To evaluate the safety and efficacy of percutaneous vertebroplasty(PVP)combined with interstitial implantation of ^(125)I seeds for the treatment of spinal metastases with destroyed posterior margin of the vertebral body.Methods The clinical data of 55 patients with spinal metastasis complicated by destroyed posterior margin of the vertebral body(75 diseased vertebrae in total),who received treatment at the Department of Interventional Radiology,First Affiliated Hospital of Henan Science and Technology University of China between June 2019 and June 2021,were respectively analyzed.Using random digitization method,the patients were randomly divided into combination group(n=25,40 diseased vertebrae in total,receiving PVP combined with interstitial implantation of ^(125)I seeds)and only PVP group(n=30,35 diseased vertebrae in total,receiving PVP only).Visual analogue scale(VAS)was used to assess the degree of pain,and Karnofsky performance score(KPS)was used to evaluate patient's physical condition.CT scan was adopted to check the bone cement leakage,and the control of tumor was assessed by MRI.The used amount of bone cement and ^(125)I seeds were recorded.Kaplan-Meier method was used to compare the survival time between the two groups.Results The surgical success rate was 100%.The mean VAS score in the combination group decreased from preoperative(8.25±0.31)points to postoperative 12-month(3.27±0.83)points,which in the only PVP group decreased from preoperative(8.53±0.21)points to postoperative 12-month(3.98±0.69)points.The differences in the postoperative one-,3-,6-,and 12-month VAS scores between the two groups were statistically significant(all P<0.05).The KPS in the combination group increased from preoperative(43.46±9.66)points to postoperative 12-month(90.05±2.06)points,which in the only PVP group increased from preoperative(41.15±8.36)points to postoperative 12-month(84.05±1.56)points,and the difference in the postoperative one-month KPS between the two groups was not statistically significa

关 键 词：经皮椎体成形术 ^(125)I粒子组织间置入术 后缘破坏的椎体转移瘤 

分 类 号：R738.1[医药卫生—肿瘤]