开放性椎体成形术治疗脊柱转移瘤和多发性骨髓瘤

目的 探讨开放性椎体成形术治疗脊柱转移瘤和多发性骨髓瘤的适应证选择和临床治疗效果.方法 自2004年6月至2007年6月,对22例患者施行了开放性后路椎管减压内固定联合椎体成形术,5例为多发性骨髓瘤,17例为脊柱转移瘤.患者年龄36～75岁,平均56.9岁.所有患者术前均有严重的背痛或腰痛并伴有不同程度的下肢神经损害症状,平均疼痛VAS评分为7.4分(5～10分),55个以上椎体节段进行了治疗.术后第3天评估患者的疼痛缓解情况、活动能力的改善情况.出院后每3个月门诊随访1次.结果 所有患者术后3 d内疼痛缓解,平均VAS评分降至1.8分,且术前神经损害情况改善.椎体成形术中骨水泥的平均注入量为4 m1(3～6 ml).12例术中出现骨水泥泄漏,5例在椎间隙,5例在椎旁静脉,2例椎管内渗漏.术后患者均接受化疗和(或)放疗,平均随访18个月(6～36个月),14例死于原发病,8例患者病情稳定.结论 此手术一次性完成椎管减压内固定,稳定脊柱,同时行椎体成形术,可以提高患者的活动能力,减轻疼痛,临床效果显著,尤其对于体质较差,多椎体病变,椎体压缩骨折压迫脊髓,无法承受脊柱前路手术的患者提供了一种可选择的手术方式.

Open vertebroplasty for the management of spinal metastases and multiple myeloma

Objective To evaluate the indication and clinical significance of open vertebroplasty for the management of spinal metastases and multiple myeloma. Methods From June 2004 to June 2007, 22 patients were undergone surgical spinal cord decompression, combined with posterior instrumentation-assist- ed stabilization, and during the same open intervention in which the vertebral body fracture was stabilized by vertebroplasty. There were 5 patients with multiple myeioma and 17 patients with metastases, with the mean age of 56.9 years (range, 36-75 years). All patients complained severe back or lumbar pain, and symptoms neurological deficits of lower limbs preoperatively. The mean visual analog scale (VAS) was 7.4 (ranged 5- 10). More than 55 vertebral levels were treated. All patients received postoperative chemotherapy and/or ra- diotherapy. The alleviation of pain and capbility of movement were evaluated 3 days after operations. All out-hospital patients were followed up every 3 months. Results The pain was dramatically reduced 3 days after the operation, the mean VAS score decreased to 1.8, neurological dysfunction was improved. Cement leaks were revealed in 12 cases, but no procedure-related complications occurred. The mean follow-up pe- riod was 18 months (range, 6-36 months). 14 patients died of their diseases, and the other 8 remained sta- ble. Conclusions The open vertebroplasty can alleviate the spinal cord symptoms, consolidate the deterio- rated vertebral body and stabilizate the vertebral column during the same session. This procedure can pro- vide an alternative treatment for patients with spinal metastases and multiple myeloma, who axe in poor gen- eral health and not able to bear anterior vertebrectomy.