[1]谢炜星,万超,晋大祥,等.经皮椎体强化术治疗脊柱溶骨性肿瘤[J].中医正骨,2015,27(09):50-53.
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经皮椎体强化术治疗脊柱溶骨性肿瘤()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第27卷
期数:
2015年09期
页码:
50-53
栏目:
临床报道
出版日期:
2015-09-30

文章信息/Info

作者:
谢炜星万超晋大祥丁金勇徐继禧马辉张顺聪梁德
广州中医药大学第一附属医院,广东 广州 510405
关键词:
脊椎肿瘤 椎体成形术 椎体转移瘤 多发性骨髓瘤
摘要:
目的:观察经皮椎体强化术治疗脊柱溶骨性肿瘤的临床疗效。方法:2012年1月至2014年4月,采用经皮椎体强化术治疗脊柱溶骨性肿瘤患者17例45椎,男10例、女7例。年龄26~87岁,中位数60岁。脊柱转移瘤9例20椎,其中原发肺癌转移6例15椎,子宫颈癌转移1例2椎,脑膜恶性黑色素瘤转移1例2椎,原发病灶不明确1例1椎; 多发性骨髓瘤8例25椎。按照美国东部肿瘤协作组(eastern cooperative oncology group,ECOG)体力状态分级,4级6例、3级8例、2级1例、1级2例。所有患者均经CT检查确定椎体存在溶骨性破坏或成骨溶骨混合性破坏; 均经非手术治疗后严重疼痛无法缓解。术后随访观察疼痛改善、体力状态改善情况。结果:15例行经皮椎体成形术,2例行经皮椎体后凸成形术。骨水泥注入量(5.12±1.85)mL。所有患者均获得随访,随访时间8 d至30个月,中位数6个月。5例患者死亡,其中术后8 d死亡1例、术后3个月死亡2例、术后6个月死亡1例、术后12个月死亡1例。疼痛视觉模拟评分由术前(8.0±1.5)分降至术后(2.8±1.2)分、术后1个月(2.1±2.1)分、术后3个月(1.8±1.5)分。术后1个月患者ECOG体力状态分级,4级2例、3级4例、2级5例、1级5例。20个脊柱转移瘤椎体中有13个椎体发生骨水泥渗漏,25个多发性骨髓瘤椎体中有10个椎体发生骨水泥渗漏; 所有患者均未因骨水泥渗漏引起临床症状需进一步处理。结论:采用经皮椎体强化术治疗脊柱溶骨性肿瘤,可以缓解疼痛症状,改善体力状态,提高患者的生活质量,值得临床推广应用。

参考文献/References:

[1] Chiras J,Barragn-Campos HM,Cormier E,et al.Percutaneous vertebroplasty:state of the art[J].Journal de Radiology,2007,88(9):1255-1260.
[2] Murphy KJ,Deramond H.Percutaneous vertebroplasty in benign and malignant disease[J].Neuroimaging Clin N Am,2000,10(3):535-545.
[3] Oken MM,Creech RH,Tormey DC,et al.Toxicity and response criteria of the Eastern Cooperative Oncology Group[J].Am J Clin Oncol,1982,5(6):649-655.
[4] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:123-124.
[5] Galibert P,Deramond H,Rosat P,et al.Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty[J].Neurochirurgie,1987,33(2):166-168.
[6] Fourney DR,Schomer DF,Nader R,et al.Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients[J].J Neurosurg,2003,98(1 Suppl):21-30.
[7] 周伟,葛崇华.脊柱转移瘤的诊断与治疗[J].中国脊柱脊髓杂志,2003,13(3):40-42.
[8] Simmons ED,Zheng Y.Vertebral tumors:surgical versus nonsurgical treatment[J].Clin Orthop Relat Res,2006,443:233-247.
[9] Anselmetti GC,Corgnier A,Debernardi F,et al.Treatment of painful compression vertebral fractures with vertebroplasty:results and complications[J].Radiol Med,2005,110(3):262-272.
[10] 徐宝山,胡永成,唐天驷,等.经皮椎体成形术在脊柱溶骨性肿瘤中的应用[J].中华骨科杂志,2004,24(2):34-38.
[11] 倪才方,杨惠林,唐天驷.经皮椎体成形术的初步临床应用[J].介入放射学杂志,2002,11(4):275-277.
[12] Mikami Y,Numaguchi Y,Kobayashi N,et al.Therapeutic effects of percutaneous vertebroplasty for vertebral metastases[J].Jpn J Radiol,2011,29(3):202-206.
[13] Berenson J,Pflugmacher R,Jarzem P,et al.Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer:a multicentre,randomised controlled trial[J].Lancet Oncol,2011,12(3):225-235.
[14] Masala S,Nselmetti GC,Arcia S.et al.Percutaneous vertebroplasty in multiple myeloma vertebral involvement[J].J Spinal Disord Tech,2008,21(5):344-348.
[15] 杨祚璋,许建波,曾才铭,等.经皮穿刺椎体成形术治疗多发性骨髓瘤椎体病理性骨折的初步探讨[J].中国修复重建外科杂志,2005,19(12):1040-1041.
[16] 黄海汛,范海泉,陈铭,等.经皮椎体成形术治疗多发性骨髓瘤的临床疗效[J].脊柱外科杂志,2014,12(2):100-102.
[17] 陈钢,黄宏伟,陈永雄,等.经皮椎体成形术治疗多发性骨髓瘤椎体病理性骨折[J].中国矫形外科杂志,2012,20(15):1436-1437.
[18] Kasperk C,Haas A,Hillengass J,et al.Kyphoplasty in patients with multiple myeloma a retrospective comparative pilot study[J].J Surg Oncol,2012,105(7):679-686.
[19] Lee CS,Jung CH.Metastatic spinal tumors[J].Asian Spine J,2012,6(1):71-87.
[20] 许国华,叶晓健,袁文,等.椎体成形术对胸腰椎椎体转移癌疼痛的治疗[J].中国脊柱脊髓杂志,2006,16(7):508-511.
[21] 方宜宥,周辉,彭亮,等.经皮椎体后凸成形术中骨水泥渗漏的原因与预防策略[J].中医正骨,2013,25(4):69-70.
[22] 张文财,秦丰伟,刘洪江,等.经皮椎体后凸成形术研究进展[J].中医正骨,2013,25(8):64-67.
[23] Nieuwenhuijse MJ,Van Erkel AR,Dijkstra PD.Cement leakage in percutaneous vertebroplasty for osteoporotic vertebral compression fractures: identification of risk factors[J].Spine J,2011,11(9):839-848.
[24] Weill A,Chiras J,Simon JM,et al.Spinal metastases:indications for and results of percutaneous injection of acrylic surgical cement[J].Radiology,1996,199(1):241-247.
[25] Cotten A,Dewatre F,Cortet B,et al.Percutaneous vertebroplasty for osteolytic metastases and myeloma:effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up[J].Radiology,1996,200(2):525-530.

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备注/Memo

备注/Memo:
2015-01-23收稿 2015-03-20修回
更新日期/Last Update: 2015-09-30