论文部分内容阅读
目的观察经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗颈椎溶骨性骨转移癌并行颈椎功能重建的可行性、安全性及其术式探讨。方法2005年3月-2007年12月,采用PVP治疗颈椎单一椎体溶骨性骨转移癌患者10例。男5例,女5例;年龄38～75岁,平均54.5岁。原发肿瘤:肺癌5例,肾癌、宫颈癌、乳腺癌各1例,原发肿瘤部位不明2例。病程2～4年。椎体转移位于C2 4例,C3、C6、C7各2例,均有明显颈部疼痛及活动受限;术前检查患者一般状况均平稳,无凝血功能障碍、神经根痛或脊髓受压等症状。6例行侧方PVP,经椎动脉与颈动脉鞘间入路;4例行前外侧PVP,经气管及颈内动脉鞘间入路。术中骨水泥填充量为3～4 mL,填充率为50%～100%。结果所有患者穿刺过程均顺利,无明显出血或器官损伤。术中疼痛1例;术后立即行CT或X线检查发现椎旁硬膜外骨水泥渗漏2例,横突孔骨水泥渗漏1例,针道返流3例,均无神经系统受压症状。术后疼痛均有不同程度缓解,术前疼痛视觉模拟评分为(5.9±1.2)分,术后1 h为(2.6±1.2)分,术后1周为(1.6±1.3)分,各时间点两两比较差异均有统计学意义(P<0.05)。于术后1周、6个月和12个月对患者定期随访,所有患者均无椎体滑脱、脊髓受压、瘫痪等神经系统症状出现。3例于术后6个月死亡,2例于术后12个月死亡,死亡原因均为原发肿瘤进展致多器官功能衰竭;余患者颈椎局部疼痛控制且功能恢复良好。结论颈椎PVP止痛快,椎体稳定性恢复满意,并发症轻微;经侧方入路途径安全有效。
Objective To investigate the feasibility, safety and operation of percutaneous vertebroplasty (PVP) in the treatment of cervical osteolytic bone metastases with cervical spondylosis. Methods From March 2005 to December 2007, PVP was used in the treatment of 10 cases of single osteolytic bone metastases of cervical spine. 5 males and 5 females; aged 38 to 75 years, mean 54.5 years old. Primary tumors: 5 cases of lung cancer, kidney cancer, cervical cancer, breast cancer in 1 case, the primary tumor site unknown 2 cases. Course of 2 to 4 years. Vertebral body metastases were located in 4 cases of C2, 2 cases of C3, C6, C7, each with obvious neck pain and limited activity. The patients in the preoperative examination were stable and had no coagulation dysfunction, nerve root pain or spinal cord compression symptom. 6 cases of lateral PVP, through the intervertebral artery and carotid sheath interventricular route; 4 cases of anterolateral PVP, the trachea and internal carotid artery intercostal approach. Intraoperative bone cement filling volume of 3 ~ 4 mL, filling rate of 50% to 100%. Results All patients underwent puncturing smoothly with no obvious bleeding or organ damage. Intraoperative pain in 1 case; CT or X-ray examination immediately after surgery found paravertebral epidural bone cement leakage in 2 cases, transverse hole cement leakage in 1 case, 3 cases of needle-hole reflux, no neurological compression symptom. The postoperative pain relief was relieved to varying degrees. The visual analogue scale of preoperative pain was (5.9 ± 1.2) points and 2.6 ± 1.2 points at 1 hour after surgery and (1.6 ± 1.3) points at 1 week after surgery respectively. At each time point The differences between each two groups were statistically significant (P <0.05). The patients were followed up regularly for 1 week, 6 months and 12 months after operation. All patients had no symptoms of nervous system such as vertebral body slippage, spinal cord compression and paralysis. Three patients died at 6 months after operation and 2 patients died at 12 months after operation. The causes of death were multiple organ failure due to primary tumor progression. The remaining patients had local pain control and functional recovery of cervical spine. Conclusions Cervical PVP pain relief, vertebral stability recovery satisfactory, minor complications; safe and effective by the lateral approach.