C臂CT结合X线透视引导下经皮椎体成形术治疗疼痛性上胸椎转移癌

目的 评估C臂CT结合X线透视引导下经皮椎体成形术（PVP）治疗疼痛性上胸椎转移癌的安全性、可行性及疗效。方法 回顾性分析接受C臂CT结合X线透视引导下PVP治疗的18例（19个病变椎体）疼痛性上胸椎转移癌患者的资料。记录病变椎体部位、术中透视时间、C臂CT扫描次数、骨水泥用量、骨水泥渗漏及并发症情况。记录患者术前及术后1天、1周、1个月及3个月的疼痛视觉模拟（VAS）评分，比较治疗前后VAS评分的差异，计算止痛有效率。结果 19个病变椎体，分别为T1 2个，T2 5个，T3 3个，T4 9个。PVP术后3个月内止痛有效率为88.89%（16/18），术后患者VAS评分较术前明显降低（P均<0.05）。PVP术中椎体平均透视时间为（14.76±3.14）min，C臂CT扫描次数（3.32±0.13）次，骨水泥用量（2.66±0.70）ml。无症状骨水泥渗漏率为31.58%（6/19）。无PVP相关并发症发生。结论 C臂CT结合X线透视引导下PVP治疗疼痛性上胸椎转移癌操作安全、方法可行，止痛效果好。

C-arm CT combined with fluoroscopy-guided percutaneous vertebroplasty in treatment of painful metastatic tumors of upper thoracic spine

Objective To evaluate the safety, feasibility and efficacy of C-arm CT combined with fluoroscopy-guided percutaneous vertebroplasty (PVP) in treatment of painful metastatic tumors of the upper thoracic spine. Methods Totally 18 patients (19 vertebrae) with painful metastatic tumors of the upper thoracic spine were treated with C-arm CT combined with fluoroscopy-guided PVP. The distribution of the lesions, fluoroscopy duration, C-arm CT scan times, the amount of bone cement, the cement leakage and the complications during PVP were recorded. The visual analogue scale (VAS) scores before PVP, 1 day, 1 week, 1 month and 3 months after PVP were also recorded. VAS scores before and after treatment were compared, and the analgesic efficiency was calculated. Results These 19 lesions located at T1 (n=2), T2 (n=5), T3 (n=3) and T4 (n=9). The effective rate of analgesia 3 months after PVP was 88.89% (16/18). The post-operation VAS score was significantly lower than that pre-operation (all P<0.05). The mean vertebral fluoroscopy duration in PVP was (14.76±3.14)min. The scan times of C-arm CT was (3.32±0.13) times. The amount of bone cement for each vertebra was (2.66±0.70)ml. The asymptomatic bone cement leakage rate was 31.58% (6/19). No PVP related complications occurred. Conclusion C-arm CT combined with fluoroscopic guided PVP can be used as an alternative treatment for painful metastatic tumors of the upper thoracic spine due to its safety, feasibility and excellent analgesic effectiveness.