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目的探讨数字减影血管造影(digitalsubtractionangiography,DSA)机引导下经皮椎体成形术(percutaneousvertebroplasty,PVP)治疗脊柱肿瘤患者的临床疗效。方法2002年1月~2005年1月对196例脊柱肿瘤患者采用PVP术。其中男99例,女97例,年龄23~85岁,平均60.4岁。176例为脊柱转移瘤,原发肺癌66例,乳腺癌55例,肝癌19例,大肠癌15例,胃癌9例,前列腺癌12例;多发性骨髓瘤16例;脊柱恶性淋巴瘤4例。累计颈椎32例,胸椎93例,腰椎71例。脊椎节段1个节段135例,2个节段50例,>3个节段11例。术后进行常规化疗及其他综合治疗。观察患者视觉模拟疼痛评分(visualanaloguepainscale,VAS)的变化,X线片测量病椎前缘、中线和后缘高度的变化。结果196例279节椎体成形术获得成功,手术穿刺成功率100%。每节椎体注射骨水泥1~9ml。术后X线片及CT检查显示所有患者均取得脊柱的稳定。随访6个月~3年,193例(98.5%)患者术后腰背部疼痛明显减轻或消失,3例(1.5%)改善不明显,手术前后VAS评分比较差异有统计学意义(P<0.05)。病椎的平均前缘高度(术前15.71±2.80mm,术后16.61±3.01mm),中线高度(术前13.65±2.93mm,术后14.52±2.72mm),后缘高度(术前23.67±2.81mm,术后23.70±3.13mm),手术前后比较差异有统计学意义(P<0.05)。随访期内肺癌和肝癌的平均生存时间为9个月,乳腺癌、胃肠道癌、前列腺癌、淋巴瘤和其他转移肿瘤的平均生存时间为18个月,多发性骨髓瘤平均生存时间27个月,比较差异有统计学意义(P<0.01)。结论PVP具有创伤小、操作简便、并发症少的特点,可有效缓解脊柱转移瘤患者疼痛,稳定脊柱,改善其生活质量,并能降低截瘫发生率。
Objective To investigate the clinical efficacy of percutaneous vertebroplasty (PVP) guided by digital subtraction angiography (DSA) in patients with spinal tumors. Methods From January 2002 to January 2005, 196 patients with spinal tumors were treated with PVP. There were 99 males and 97 females, aged 23-85 years old, with an average age of 60.4 years. 176 cases of spinal metastases, 66 cases of primary lung cancer, 55 cases of breast cancer, 19 cases of liver cancer, 15 cases of colorectal cancer, 9 cases of gastric cancer, 12 cases of prostate cancer; multiple myeloma in 16 cases; 4 cases of spinal malignant lymphoma. Total 32 cases of cervical, thoracic 93 cases, 71 cases of lumbar. One segment of the spine segment was 135 cases, two segments of 50 cases,> 3 segments in 11 cases. After conventional chemotherapy and other comprehensive treatment. The changes of visual analog pain scale (VAS) were observed. The changes of the anterior, midline and posterior border of the vertebrae were measured by X-ray. Results 196 cases of 279 vertebroplasty were successful, the success rate of surgical puncture was 100%. Each vertebral bone injection 1 ~ 9ml. Postoperative X-ray and CT examination showed that all patients achieved stable spine. After 6 months to 3 years of follow-up, 193 patients (98.5%) had obvious reduction or disappearance of postoperative low back pain and no obvious improvement in 3 cases (1.5%). There was significant difference in VAS scores before and after operation (P <0.05) . The mean height of the vertebra (15.71 ± 2.80mm before operation and 16.61 ± 3.01mm after operation), the midline height (13.65 ± 2.93mm before operation and 14.52 ± 2.72mm after operation), the height of the posterior border (23.67 ± 2.81 mm, postoperative 23.70 ± 3.13mm), the difference was statistically significant before and after surgery (P <0.05). The average survival time of lung cancer and liver cancer during the follow-up period was 9 months. The mean survival time of breast cancer, gastrointestinal cancer, prostate cancer, lymphoma and other metastatic tumors was 18 months. The mean survival time of multiple myeloma was 27 Month, the difference was statistically significant (P <0.01). Conclusion PVP has the advantages of less trauma, simple operation and less complications. It can effectively relieve the pain, stabilize the spine, improve the quality of life and reduce the incidence of paraplegia in patients with spinal metastases.