经皮椎体成形术及经皮椎体后凸成形术治疗椎体转移瘤的临床应用

目的：探讨经皮椎体成形术（PercutaneousvertebroplastyPVP）及经皮椎体后凸成形术（KyphoplastypereutaneousPKP）治疗椎体转移性肿瘤的临床疗效。方法：对38例共44个椎体行PVP，7例9个椎体行PKP，术前VAS标准（visualanalogscale，VAS）评分。结果：45例53个椎体手术无死亡病例。术前轻度疼痛4例，中度11例，剧痛31例。术前VAS评分平均为9．2±2．2分。术后3天疼痛完全缓解38例（84．4％）；部分缓解5例（11．1％）；轻微缓解1例（2．2％）；NR1例（2．2％）；有效为95．5％，VAS评分2．0±1．4，与术前比较差异有统计学意义（P〈0．05）；53个椎体术中骨水泥渗漏至椎间盘3例，硬膜外囊2例，椎旁静脉丛1例，椎旁软组织3例；骨水泥外漏发生率16．98％，其中PKP仅发生椎旁软组织外渗1例，术中及术后均无其它并发症发生。PVP式Cobb’s角术前19．3±8．7，术后为18．4±7．8；PKP术前为22．1±8．7，术后为12．2±5．8，术后Cobb’s角与术前比较，PKP术式差异有统计学意义（P〈0．01），PVP术式差异无统计学意义（P〉0．05）；轻度疼痛及中度疼痛完全缓解及部分缓解为100％；重度疼痛完全缓解及部分缓解为93．6％，轻微缓解及无效为6．4％，轻、中、重度各级术后较术前疼痛缓解明显，差异有统计学意义（P〈0．05）。结论：PVP及PKP对缓解或消除由椎体转移性肿瘤引起的疼痛有明显的治疗效果，无严重并发症。PKP术对塌陷椎体高度有一定程度恢复。

The Clinical Application of Percutaneous Vertebroplasty or Kyphoplasty Percutaneous Treatment for Vertebral Metastases

Objective： To investigate percutaneous vertebroplasty （PVP） or percutaneous kyphoplasty （PKP） treat- ment for vertebral metastases. Methods： PVP was performed in 38 patients with 44 vertebrae involvement and PKP was performed in 7 patients with 9 vertebrae involvement. VAS （ visual analog scale, VAS） score was evaluated before opera- tion. Results： No operation-related death occurred in the 45 cases. There were 4 cases with mild pain , 11 moderate pain and 31 severe pain before operation with the average VAS was 9.2 ＋2.2. Complete remission of pain was got in 38 cases （84.4%） ,partial remission in 5 cases（ 11.1% ） ,slight remission in 1 case（2.2% ） and NR in 1 case（2.2% ） 3 days af- ter operation. The effective rate was 95.5% with VAS score was 2.0. -＋ 1.4 which was significantly lower that before oper- ation（ P 〈 0.05 ）. Bone cement leakage occurred in 9 case（ 16.98% ）, including 3 intervertebral leaks , 2 epidural leaks, 1 paravertebral venous plexus and 3 paravertebral soft tissue soft tissue leaks; only 1 paravertebral soft tissue leaks occured after PKP. Cobb＇s angle was 19.3 -＋ 8.7 preoperation and 18.4 ＋ 7.8 postoperation after PVP without significant differ- ence（P 〉 0.05）. It was 22.1 _＋ 8.7 preoperation and 12.2 ＋ 5.8 postoperation in PKP with significant difference（P 〈 0.01 ）. CR and PR of mild pain and moderate pain was 100% ,93.6% of severe pain. MR and NR was 6.4% for severe pain. Pain at different level was statistically relieved after operation（ P 〈 0.05 ）. Conclusion： PVP and PKP could providesignificant pain relief in vertebral metastases; PKP could recover collapsed vertebral body in some degrees.