^125I放射性粒子联合PKP治疗脊柱转移瘤的临床研究

目的：评估125I放射性粒子植入联合椎体后凸成形术（percutaneouskyphoplasty，PKP）在治疗胸腰椎转移瘤中的应用价值。方法选取2009年1月至2013年12月，拟行经皮椎体成形术的胸腰椎转移瘤患者，对其是否联合125I放射性粒子植入术分为研究组与对照组。观察并记录术前及术后2周、1、3、6、12个月的VAS评分（visualanaloguescale）及KPS评分（karnofskyperformancescore），比较两组各项指标的变化情况。结果研究组21例，对照组25例，手术均顺利完成，无围手术期死亡病例。所有病例均随访12～60个月，平均（37.5±15.9）个月，未发现骨水泥渗漏，研究组病例未发现放射性粒子移位或放射性脊髓损伤。研究组及对照组术前VAS评分分别为8.44±1.32、8.7±1.83，两组术后2周、1、3、6、12个月VAS分别为2.79±3.46、3.21±2.53、2.96±2.16、3.08±2.03、3.17±1.24及4.23±2.78、3.42±2.21、3.63±1.76、3.58±2.53、3.62±3.12，手术前后比较有统计学意义（P＜0.05），且研究组较对照组改善更明显（P＜0.05），说明联合125I放射性粒子植入止痛效果更明显。研究组和对照组术前KPS分别为55.0±11.7及60.9±16.4，术后2周，1、3、6、12个月分别为85.7±12.5、89.7±10.6、81.96±14.4、82.1±11.3、81.3±11.2及91.2±12.7、90.4±13.1、88.6±13.3、86.8±12.3、83.6±13.2，术后KPS分别较术前明显改善，但在术后2周、1、3、6、12个月各时间点的KPS评分两组间差异无统计学意（P＞0.05），说明手术对于患者体力恢复的作用无明显差别。结论125I放射性粒子植入术联合PKP治疗脊柱转移瘤，在临床操作上安全可行，能达到缓解癌性疼痛、局部肿瘤控制、重建脊柱稳定性的作用，短期疗效可靠，为脊柱转移瘤患者提供了一种新的有效治疗方法。在疼痛控制方面，联合125I放射性粒子植入术较单纯椎体成形术效果更佳。

Clinical research on implantation of radioactive Iodine-125 seeds combined with percutaneous kyphoplasty for spinal metastases

Objective To evaluate the clinical value of implantation of Iodine-125 （ 125I ） radioactive seeds combined with ercutaneous kyphoplasty （ PKP ） in the treatment of thoracolumbar metastases. Methods PKP was planned for the patients with thoracolumbar metastases admitted from January 2009 to December 2013. All the patients were allocated to the study group and the control group depending on whether 125I radioactive seeds were implanted. The Visual Analogue Scale （ VAS ） and Karnofsky Performance Score （ KPS ） were recorded preoperatively and at 2 weeks, 1 month, 3 months, 6 months and 12 months after the operation, and the changes were compared between the 2 groups. Results There were 21 cases in the study group and 25 cases in the control group. The operation was successfully performed in all the patients, without perioperative deaths. The average follow-up period was （ 37.5±15.9 ） months （ range：12-60 months ）. There was no leakage of bone cement. No seeds migration or radioactive myelitis was observed in the study group. The preoperative VAS score was 8.44±1.32 points in the study group, which were 2.79±3.46, 3.21±2.53, 2.96±2.16, 3.08±2.03 and 3.17±1.24 points respectively at 2 weeks, 1 month, 3 months, 6 months and 1 year after the operation. The VAS scores in the control group were 8.7±1.83, 4.23±2.78, 3.42±2.21, 3.63±1.76, 3.58±2.53 and 3.62±3.12 points respectively at the same time points. The preoperative and postoperative VAS scores were signiifcantly different in both groups （ P〈0.05 ）, and the improvement was more obviously shown in the study group （ P〈0.05 ）. It was illustrated that implantation of 125I radioactive seeds promoted the relief of pain. The preoperative KPS score in the study group was 55.0±11.7 points, which was 85.7±12.5, 89.7±10.6, 81.96±14.4, 82.1±11.3 and 81.3±11.2 points respectively at 2 weeks, 1 month, 3 months, 6 months and 1 year after the operation. In the control group, the KPS scores were 60.9±16.4, 91.2±12.7, 90.4±13