数字减影血管造影机引导下经皮椎体成形术治疗脊柱肿瘤的临床研究

目的探讨数字减影血管造影(digitalsubtractionangiography,DSA)机引导下经皮椎体成形术(percutaneousvertebroplasty,PVP)治疗脊柱肿瘤患者的临床疗效。方法2002年1月~2005年1月对196例脊柱肿瘤患者采用PVP术。其中男99例,女97例,年龄23~85岁,平均60.4岁。176例为脊柱转移瘤,原发肺癌66例,乳腺癌55例,肝癌19例,大肠癌15例,胃癌9例,前列腺癌12例;多发性骨髓瘤16例;脊柱恶性淋巴瘤4例。累计颈椎32例,胸椎93例,腰椎71例。脊椎节段1个节段135例,2个节段50例,>3个节段11例。术后进行常规化疗及其他综合治疗。观察患者视觉模拟疼痛评分(visualanaloguepainscale,VAS)的变化,X线片测量病椎前缘、中线和后缘高度的变化。结果196例279节椎体成形术获得成功,手术穿刺成功率100%。每节椎体注射骨水泥1~9ml。术后X线片及CT检查显示所有患者均取得脊柱的稳定。随访6个月~3年,193例(98.5%)患者术后腰背部疼痛明显减轻或消失,3例(1.5%)改善不明显,手术前后VAS评分比较差异有统计学意义(P<0.05)。病椎的平均前缘高度(术前15.71±2.80mm,术后16.61±3.01mm),中线高度(术前13.65±2.93mm,术后14.52±2.72mm),后缘高度(术前23.67±2.81mm,术后23.70±3.13mm),手术前后比较差异有统计学意义(P<0.05)。随访期内肺癌和肝癌的平均生存时间为9个月,乳腺癌、胃肠道癌、前列腺癌、淋巴瘤和其他转移肿瘤的平均生存时间为18个月,多发性骨髓瘤平均生存时间27个月,比较差异有统计学意义(P<0.01)。结论PVP具有创伤小、操作简便、并发症少的特点,可有效缓解脊柱转移瘤患者疼痛,稳定脊柱,改善其生活质量,并能降低截瘫发生率。

CLINICAL STUDIES ON TREATMENT OF PATIENTS WITH MALIGNANT SPINAL TUMORS BY PERCUTANEOUS VERTEBROPLASTY UNDER GUIDANCE OF DIGITAL SUBTRACTION ANGIOGRAPHY

OBJECTIVE: To investigate the clinical therapeutic effects on malignant spinal tumors treated by percutaneous vertebroplasty (PVP) under the guidance of the digital subtraction angiography (DSA). METHODS: A retrospective analysis was performed in 196 patients (99 males and 97 females, aged 23-85 years, averaged 60.4 years) with malignant spinal tumors, who underwent the PVP treatment combined with standard chemotherapy and other comprehensive treatment from January 2002 to January 2005. The malignant spinal tumors had their origins as follows: lung cancer (66 cases), breast cancer (55 cases), liver cancer (19 cases), colon cancer (15 cases), stomach cancer (9 cases), prostate cancer (12 cases), multiple myeloma (16 cases), and malignant lymphoma of the spine (4 cases). The metastatic tumors involved the cervical vertebra (32 cases), thoracic vertebra (93 cases), lumbar vertebra (71 cases), and spinal column, including 1 vertebral segment (135 cases), 2 segments (50 cases), and more than 3 segments (11 cases). During the follow-up survey, changes in the visual analogue pain scale (VAS) and changes in the X-ray measurements of the average anterior height, midline height, and posterior height of the diseased vertebra were observed. RESULTS: The follow-up for 6 months to 3 years revealed that the percutaneous vertebroplasty on 279 vertebral segments had a success with an operational success rate of 100%. Bone cement was injected into the lesions 1-9 ml per segment of the spine. The postoperative X-ray and CT evaluations revealed that spinal stabilization was obtained in all the patients. After operation, 193 (98.5%)patients had an obvious decrease or disappearance of the pain in the lower back, and only 3 (1.5%) patients had no obvious improvement in the pain. There was a significant statistical difference in the VAS scores between before operation and after operation (P < 0.05). There were also significant statistical differences in the average anterior height of the diseased vertebra between before operation and after operation (15.71 +/- 2.80 mm vs. 16.61 +/- 3.01 mm), in the midline height (13.65 +/- 2.93 mm vs. 14.52 +/- 2.72 mm), and in the posterior height (23.67 +/- 2.81 mm vs. 23.70 +/- 3.13 mm, P < 0.05). The patients with lung or liver cancer had a mean survival time of 9 months after PVP; the patients with breast cancer, stomach cancer, prostate cancer, lymphoma, or other metastatic tumors had a mean survival time of 18 months. The patients with multiple myeloma had a mean survival time of 27 months. The differences were statistically different (P < 0.01). CONCLUSION: PVP under the guidance of the DSA is an easier operation with a small wound and few complications. It can effectively alleviate the patient's pain due to metastatic spinal tumor, stabilize the spine, improve the patient's quality of life, and reduce the incidence of paraplegia.