经皮椎体成形术治疗脊椎恶性肿瘤

目的通过评价经皮椎体成形术治疗脊椎恶性肿瘤的临床疗效，分析与疗效的相关因素，提高治疗技术。方法173例次，239节椎体病变，经病史、影像学或病理证实椎体恶性肿瘤行PVP术，临床疼痛症状为Ⅰ级(轻度疼痛)39例，Ⅱ级(中度疼痛)84例，Ⅲ级(重度疼痛)50例。术后采用WHO标准观察1周～1个月，平均2周。结果239节椎体穿刺失败1例1节椎体，技术成功率99．6％，共197个椎体行术前造影检查：造影剂经肿瘤破坏区向椎体外渗漏57节椎体，6例6节椎体有造影剂进入相邻椎间盘；注入聚甲基丙烯酸甲酯(PMMA)剂量颈椎1．5～2．5ml，胸椎为2～4ml，腰椎为2～6ml；短期内疗效显示疼痛完全缓解54．9％，部分缓解39．9％，总有效率94．8％。术后CT证实PMMA向椎体周围组织渗漏63例，包括9例引流静脉、4例椎管内硬膜囊外和3例渗漏入相邻椎间盘，47例向椎体旁渗漏，仅1例瘫痪患者出现临床症状加重。结论PVP短期内可明显减轻脊椎恶性肿瘤所致的疼痛症状。术前对脊椎恶性肿瘤的准确评估，结合术中椎体内造影，严格掌握注射时机，可提高治疗疗效，避免严重并发症的发生。

Percutaneous vertebroplasty for spinal malignant tumors: A report of 173 cases

Objective To evaluate the safety and efficacy of percutaneous vertebroplasty for the treatment of vertebral malignant tumors. The related factors with efficacy were analysed for improving the therapeutic technique. Methods PVP was performed in 173 consecutive patients with 239 vertebral malignant tumors verified by the history, imaging and pathology. Among them, 39 cases had minor back pain, 84 with moderate and 50 with severe pain before the procedure. The efficacy was estimated during 1 week to 1 month after the procedure. Results The success rate of technique reached 99.6% (238/239 levels). Contrast material injection after the needle placement within the vertebral body was undertaken in 197 vertebras. As a result, 57 paravertebral leakages and 6 cases with intervertebral leakage were seen before injecting PMMA cement. The amount of cement injected into cervical, thoracic and lumber vertebrae were 1.5-2.5 ml, 2-4 ml (mean 3.3 ml)and 2-6 ml (mean 4.5 ml) respectively, with CR and PR of 54.9% and 39.9% respectively. There were 63 paravertebral leaks, including 9 draining vein leaks, 4 epidural and 3 intervertebral leaks detected by CT scan. Only one patient went worse with paralysis before the procedure. Conclusions PVP may provide significant pain relief in vertebral malignant lesions for a short term. Evaluation of the lesions in vertebrae with the vertebral venography before hand is the key factor for the proper using of PMMA to improve efficacy and avoid severe complications.