新型Vessel-X经皮椎体强化系统治疗溶骨性后壁破损型椎体转移瘤

目的:评估Vessel-X经皮椎体强化系统(Vesselplasty)治疗溶骨性后壁破损型椎体转移瘤的临床疗效和安全性。方法:对2016年1月至2019年1月收治的19例(21个节段)溶骨性后壁破损的椎体转移瘤患者进行回顾性分析,男15例,女4例;年龄40～85(66.00±10.25)岁,术前均因腰背部的疼痛剧烈影响生活前来就诊,均通过CT诊断为椎体后壁破损型转移瘤。所有患者采用Vesselplasty技术进行治疗,其中19个椎体采取单侧椎弓根穿刺、2个椎体采取双侧椎弓根穿刺。术前及术后1、3 d分别记录视觉模拟评分(visual analogue scale,VAS),Oswestry功能障碍指数(Oswestry Disability Index,ODI),术后复查X线片及CT观察有无骨水泥渗漏情况,并记录其他并发症发生情况。结果:19例患者手术过程均顺利,术后患者疼痛显著改善,手术前后VAS评分、Oswestry功能障碍指数差异有统计学意义(P0.05);1个椎体发生少量骨水泥渗漏,为椎静脉丛渗漏,但术后无临床症状。结论:采用Vesselplasty技术治疗椎体溶骨性后壁破损型的转移瘤,可减轻患者胸腰背部疼痛症状,明显提高生活质量,骨水泥渗漏发生率较低,具有较好的临床疗效及安全性。

Vesselplasty for the treatment of spinal metastases complicated by posterior wall destruction of vertebral body

Objective: To evaluate the early clinical efficacy and safety of vesselplasty for the treatment of spinal metastases complicated by posterior wall destruction of vertebral body.Methods: The clinical data of 19 patients (21 segments) with spinal metastases complicated by posterior wall destruction of vertebral body treated from January 2016 to January 2017 were retrospectively analyzed. There were 15 males and 4 females,aged 40 to 85 years old with a mean of (66.00±10.25) years. All patients had severe low back pain before the operation,which were diagnosed by CT as damage-type metastatic tumor of the vertebral posterior wall. All patients were treated by vesselplasty technique. Nineteen vertebrae received percutaneous unilateral pedicle puncture and two vertebrae received percutaneous bilateral pedicle puncture. VAS,ODI were recorded before operation,1 d and 3 d after operation respectively. X-ray and CT scan were used to observe bone cement leakage and complications.Results: All the operations were successful and postoperative pain was significantly relieved. Postoperative VAS score and ODI of the two groups were significantly improved (P<0.05). A small amount of bone cement leakage occurred in one vertebral body,which was a vertebral venous plexus leakage,but no clinical symptoms after operation.Conclusion: Vesselplasty for the treatment of spinal metastases complicated by posterior wall destruction of vertebral body can significantly reduce the symptoms of thoracolumbar back pain,improve the quality of life,reduce the incidence of bone cement leakage,and has high clinical efficacy and safety.