经皮椎体成形术在脊柱转移瘤中的临床应用研究

摘要

目的：评价经皮椎体成形术治疗脊柱转移瘤的有效性、安全性及可行性。方法：本院2010年1月-2012年12月对18例脊柱转移瘤患者共26节病变椎体实施经皮椎体成形术治疗，术前、术后24 h、1个月、6个月、12个月、24个月分别记录患者的疼痛视觉模拟评分和OWESTRY功能障碍指数得分，用以评估患者疼痛程度缓解和日常活动能力改善的状况，并观察骨水泥的渗漏情况及临床并发症。术后随访1~24个月，平均18个月。结果：术后24 h的平均VAS评分和ODI得分分别为（2.79±0.45）、（28.50±4.70）分，均明显低于术前的（8.13±0.38）、（83.50±6.30）分，差异均有统计学意义（P<0.05），术后各个随访时段的平均VAS评分和ODI得分比较差异均无统计学意义（P>0.05）。骨水泥渗漏的发生率为38.5%。术后3例患者出现发热，对症处理后体温降至正常，1例患者出现右下肢麻痛不适，脱水对症处理后症状缓解。结论：经皮椎体成形术治疗椎体转移瘤能够达到迅速止痛和改善患者日常生活能力的效果，并且这种效果可持续到术后2年。经皮椎体成形术治疗椎体转移瘤的效果是确切的，对于椎体转移瘤的治疗是安全可行的。%Objective:To evaluate the clinical efficacy,security and feasibility of percutaneous vertebroplasty in the treatment of spinal metastases.Method:From January 2010 to December 2012,18 patients with spinal metastases(a total of 26 lesions of vertebral body) underwent percutaneous vertebroplasty procedures in our department.The pain visual analogue scale(VAS) score and Oswestry Disability Index score of all patients were recorded preoperative and postoperative 24 h,1 month,6,12,24 months,they were used to evaluate the patient pain relief and improvement in daily activities.Cement leakage and the type were assessed by radiographic measurements,meanwhile,the postoperative complications were studied.All cases were followed up for 1 month to 24 months.The mean follow-up period was 18 months.Result:The average VAS score and ODI score postoperative 24 h were (2.79±0.45),(28.50±4.70)scores,which were significantly lower than (8.13±0.38),(83.50±6.30) scores of preoperative,the differences were statistically significant(P<0.05).There were no statistically significant differences in the average VAS score and ODI score at each follow-up period(P>0.05).The incidence of bone cement leakage was 38.5%.Fever occurred in 3 patients after operation,after symptomatic treatment, the temperature fell to normal.Symptom of one patient with right leg pain discomfort relieved after dehydration symptomatic treatment.Conclusion:The percutaneous vertebroplasty in the treatment of spinal metastases can achieve rapid pain relief and improve the effect of improving the ability of daily life of patients,and the efficacy can be sustained for 2 years after surgery.The effect of percutaneous vertebroplasty in the treatment of spinal metastases is accurate,the treatment of spinal metastases is safe and feasible.