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目的:探讨CT引导下经皮椎体成形术治疗胸椎转移性肿瘤的安全性及疗效。方法:2004年4月～2006年2月共治疗胸椎转移性肿瘤患者18例,共30个椎体,患者均有顽固性胸背痛,术前VAS评分平均8.6分,伴脊髓压迫者6例,术前Frankel分级C级2例,D级4例,均应用CT引导下经皮椎体成形术行病变椎体内骨水泥注射治疗。随访观察并发症发生情况及治疗效果。结果:30个椎体在CT引导下均一次穿刺成功,单侧注射骨水泥12例,平均注入量2.75ml;双侧注射6例,平均注入量4.7ml,无骨水泥渗漏及神经损害加重情况发生。15例局麻药效消失后疼痛明显缓解,2例72h后疼痛缓解,1例无效。随访6～24个月,平均11.4个月。术后1周时VAS评分平均2.62分,末次随访时VAS评分平均2.94分,与术前比较均有显著改善(P<0.01)。末次随访时6例脊髓压迫者神经功能2例C级恢复至D级,其余均恢复至E级。2例原发灶为肝癌及1例肺癌患者死亡,其余患者手术椎体未发生新的病理性骨折及脊髓压迫加重。结论:CT引导下经皮椎体成形术具有良好的止痛及预防病理性骨折作用,是治疗胸椎转移性肿瘤安全、有效的方法。
Objective: To investigate the safety and efficacy of CT-guided percutaneous vertebroplasty in the treatment of metastatic thoracic tumors. Methods: From April 2004 to February 2006, 18 patients with metastatic thoracic tumors were treated with 30 vertebrae. All patients had refractory chest and back pain. The mean preoperative VAS score was 8.6 and the patients with spinal cord compression were 6 , Preoperative Frankel grading C grade in 2 cases, D grade in 4 cases, were applied CT-guided percutaneous vertebroplasty intramedullary vertebroplasty in the treatment of bone cement injection. Follow-up observation complication and treatment effect. Results: Thirty vertebral bodies were successfully punctured under the guidance of CT. Twelve cases received unilateral injection of bone cement with an average injection volume of 2.75 ml. Bilateral injection of 6 cases with an average injection volume of 4.7 ml resulted in no bone cement leakage and increased nerve damage The situation happened. Fifteen cases of local anesthesia disappeared after the pain was relieved, 2 cases of pain relief after 72 hours, 1 case of ineffective. Follow-up 6 to 24 months, an average of 11.4 months. The VAS score was 2.62 points at 1 week after operation and 2.94 points at the last follow-up, which was significantly improved compared with that before operation (P <0.01). At last follow-up, neurological function of 6 patients with spinal cord compression recovered to grade C in 2 cases, and the rest recovered to grade E. Two cases of primary tumor died of liver cancer and one case of lung cancer. The other patients had no new pathological fracture and spinal cord compression. Conclusion: CT-guided percutaneous vertebroplasty has a good analgesic and pathological fracture prevention and is a safe and effective method for the treatment of metastatic thoracic tumors.