椎体成形术联合放射性粒子治疗椎体转移癌的临床观察

目的 探讨经皮椎体成形术（PVP）联合放射性粒子植入治疗椎体转移癌的有效性和安全性。方法对41例胸腰椎转移癌患者的52个病变椎体，在CT引导下进行经皮椎体穿刺125I粒子组织间植入及骨水泥（PMMA）灌注成形治疗；术后随访1年，应用数字分级法（NRS）观察患者的疼痛缓解程度，EORTC-QLQ-C30问卷调查手术前后生活质量的变化，并观察治疗并发症及1年生存率和局部控制率。结果 41例患者术后1个月疼痛均获不同程度缓解，其中3、4度缓解率为82.9％（34/41）；术后EORTC评分较术前明显降低，生活质量显著提高（P＜0.05）；术后患者6个月内局部控制率为90.2％（37／41），1年生存率为73.2％（30／41）；在存活的30例患者中，1年局部控制率为93.3％（28／30）；术后有7例出现PMMA向椎体周围组织渗漏，但均无明显临床症状，未出现放疗相关不良反应。结论 在CT监视下，应用PVP联合放射性粒子植入治疗椎体转移癌具有稳定椎体和抑制肿瘤的协同作用，并且微创安全，可作为椎体转移癌的有效联合治疗方法之一。

Clinical observation of percutaneous vertebroplasty combined with radioactive seeds in the treatment of pa-tients with vertebral metastatic carcinoma

Objective To evaluate the efficacy and safety of the combination of percutaneous vertebroplasty （PVP） and radio- active seeds in the treatment of patients with vertebral metastatic carcinoma. Methods Fifty-two vertebral lesions in 41 patients with thoracic and lumbar metastatic carcinoma were treated with the CT-guided PVP and interstitial permanent 125I seed implantation plus polymethy lmethacrylate （PMMA） perfusion plasty. Patients were followed up for 1 year. The pain relief was observed using the numeric rating scale（NRS） , the quality of life of patients was investigated and analyzed by EORTC-QLQ-C30 questionnaire before and after surgery. The complications were also recorded. Results Pain relief was observed in all patients within 1 months after operation. 82. 9%（34/41） patients achieved 3 to 4 degree of pain relief. EORTC score after surgery was reduced and the quality of life was im- proved significantly（ P〈0. 05 ）. The 6-month local control rate after surgery was 90. 2% （37/41）. 30 patients（ 73.2% ） still alive after 1 year, in which with 93.3% pain remission. Although the leaking of PMMA to the vertebral surrounding tissue was found in 7 patients, no radiation-related adverse reactions were obseverd. Conclusion PVP combined with radioactive seeds implantation in the treatment of patients with vertebral metastatic carcinoma shows synergetic action in stabilizing vertebral body and inhibiting tumor under CT- guided. Moreover, it is an effective, safety and minimally invasive therapy method.