经皮球囊椎体后凸成形术治疗脊柱转移瘤

目的观察经皮球囊椎体后凸成形术(PKP)在脊柱转移瘤治疗中的临床价值。方法 33例椎体转移瘤均行PKP治疗。PKP在G臂X光机的监视下完成,行双侧椎弓根穿刺,分别置入球囊扩张椎体后注射骨水泥,对手术前后疼痛程度、活动能力及病椎高度的变化进行分析。结果 43个椎体行PKP均1次成功,平均每个胸椎注射骨水泥量(3.6±0.8)mL,腰椎(4.8±1.0)mL。术后24 h 87.8%(29/33)的患者可下地独立行走。手术前后疼痛评分、活动能力评分及病椎高度比较差别均有统计学意义(P<0.05)。术后24～48 h 31例(93.9%)患者背部疼痛部分或完全缓解,2例(6.1%)疼痛改善不明显。术中2例发生椎旁静脉内骨水泥渗漏但无临床症状;1例发生骨水泥椎管内渗漏及时改为开放手术,未发生神经受损症状;术前3例有神经根受损症状者术后缓解不明显。随访6～12个月,5例因肿瘤全身转移死亡,余存活病例未见椎体进一步压缩,疼痛明显加重等并发症发生。结论 PKP能迅速缓解椎体转移瘤引起的骨痛,有效增高压缩椎体高度,改善后凸畸形,增强病椎强度和稳定性,预防病椎进一步压缩骨折,具有简单、安全、有效等优点。

Percutaneous kyphoplasty for metastatic spinal tumor

Objective To investigate the clinical value of percutaneous kyphoplasty(PKP) for metastatic spinal tumor. Methods Thirty-three patients of metastasis vertebral tumor were treated with PKP.The PKP were performed under " G" armed fluoroscopy image guiding.The bilateral pedicle of vertebral arch puncture were taken to insert into sacculus,and then bone cement was injected.The pain levels,locomotor activity and the height of vertebral bodies were analysed before and after operation. Results All patients were successfully performed PKP.The average injection volume of bone cement in thoracic vertebra was(3.6±0.8)mL,and lumbar spine was(4.8±1.0) mL.Twenty-nine(87.8%,29/33) patients could walk independently at 24 hours after operation.There were significant defferences of pain levels,locomotor activity scales and the height of vertebral bodies before and after operation(P<0.05).Thirty-one(93.9%) patients of back pain with partial or complete remission,and two(6.1%) patients had no obvious improvement at 24-48 hours after operation.Two patients had cement leakages into paravertebral intravenous without any clinical symptoms;One patient got the vertebral canal opened for the cement leaked into vertebral canal,and no symptoms of neurological damage were finded.Three patients with symptoms of nerve root damage before operation, and there was no obvious relieve after operation.The follow-up period was 6-12 months.Five patients died in systemic tumor metastasis;No further vertebral compression and major complications occurred among the survivals until in the follow up period.Conclusion PKP is a safe and effective way to treat metastatic spinal tumor.It can quickly ease the pain caused by vertebral metastasis,effectively increase vertebral height,improve kyphosis malformation,and enhance strength and stability of the abnormal vertebral.