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目的探讨DSA引导下经皮椎体成形术(PVP)治疗成骨性脊柱转移癌的可行性及近期临床疗效。方法 2010年1月—2011年12月对23例(34个病灶)成骨性脊柱转移癌实施PVP术,其中合并成骨性病理性骨折12例。通过WHO标准、视觉模拟评分(VAS)、体力状况评分(Karnofsky-KPS)的变化情况来评价临床疗效。结果所有患者均获得手术成功,技术成功率100%。术后随访至少3个月。资料完整的20例患者中6例完全缓解(CR),10例部分缓解(PR),3例轻微缓解(MR),1例无效(NR),总有效率(CR+PR)达80.0%。术后24 h VAS评分由术前7.0±1.6分降至2.2±1.9分,术后1、3个月分别降至(2.4±2.1)分、(2.5±2.1)分。术后24 h、1个月、3个月KPS评分由术前(76.5±10.4)分分别升至(86.5±11.8)分、(88.0±12.0)分和(89.0±10.8)分。4例发生少量骨水泥渗漏,但无明显临床症状(17.4%)。结论 DSA引导下对成骨性脊柱转移癌患者行PVP术是可行、有效的,能有效缓解疼痛、稳定脊柱,改善其生活质量,并能降低截瘫发生率。
Objective To investigate the feasibility and short-term clinical efficacy of DSA-guided percutaneous vertebroplasty (PVP) in the treatment of metastatic bone tumors of the spine. Methods From January 2010 to December 2011, PVP was performed on 23 cases (34 lesions) of osteogenic spine metastases, including 12 cases with pathological bone fracture. The clinical efficacy was evaluated by WHO criteria, visual analogue scale (VAS), and physical status score (Karnofsky-KPS). Results All patients were successful in surgery, with 100% technical success rate. Follow-up at least 3 months after surgery. Of the 20 patients with complete data, 6 were complete remission (CR), 10 were partial remission (PR), 3 were mild remission (MR), 1 was ineffective (NR) and total effective rate (CR + PR) was 80.0%. The VAS score decreased from 7.0 ± 1.6 points to 2.2 ± 1.9 points at 24 h postoperatively and decreased to (2.4 ± 2.1) and (2.5 ± 2.1) points at 1 and 3 months postoperatively. The KPS scores at 24 h, 1 month and 3 months postoperatively increased from (76.5 ± 10.4) points to (86.5 ± 11.8) points, (88.0 ± 12.0) points and (89.0 ± 10.8) points respectively. In 4 cases, a small amount of cement leakage occurred, but no obvious clinical symptoms (17.4%). Conclusion Under the guidance of DSA, PVP is feasible and effective for patients with metastatic bone of the spine, which can effectively relieve pain, stabilize the spine, improve the quality of life, and reduce the incidence of paraplegia.