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目的评价经皮椎体成形术(PVP)对于各类原发腺癌转移到脊柱引发疼痛的治疗效果,特别是镇痛效果。方法 2009年以来明确原发病灶或脊柱转移肿瘤标本为腺癌的84例患者,男性46例,女性38例,年龄28~89岁,手术纳入的标准:1原发恶性肿瘤经病理学证实;2Frankel脊髓损伤分级D、E级;3卡氏评分≥60分;4肝功能、肾功能、心功能正常,能俯卧位≥2 h;5持续疼痛,药物、物理治疗等保守治疗后无明显改善;6椎体病灶以溶骨性破坏为主;7预期生存时间>3个月;8原发灶肿瘤或转移椎体取得病理报告是腺癌。统计原发肿瘤灶和转移至脊椎节段,在DSA或CT下进行椎体成形术,注入聚甲基丙烯酸甲酯(PMMA),亦称骨水泥1.5~5.0 ml,手术椎体节段1~6节不等。分别在手术前进行视觉模拟评分法(VAS)评分和手术后VAS评分。结果 84例患者均顺利完成手术,患者由手术前的VAS平均评分(6.48±1.77)分,降为术后的(2.75±1.52)分(P<0.01),术前轻度疼痛患者3例、中度疼痛33例、重度疼痛35例,术后轻度疼痛患者为57例、中度疼痛11例、重度疼痛3例,术前术后疼痛程度例数差异有统计学意义(P<0.01),镇痛药物减量或停止。结论椎体成形术是治疗脊柱转移性腺癌的有效方法之一,可以减少癌症患者镇痛药物的使用,增强患者的生活自理能力。
Objective To evaluate the therapeutic effect of percutaneous vertebroplasty (PVP) on the pain caused by the metastasis of various types of primary adenocarcinoma to the spine, especially the analgesic effect. Methods A total of 84 patients (46 males and 38 females, aged 28-89 years) with definite primary or spine metastatic tumor samples for adenocarcinoma since 2009 were enrolled in this study. The primary malignant tumors were confirmed by pathology. 2Frankel spinal cord injury grading D, E grade; 3 Card’s score ≥60 points; 4 liver function, renal function, normal heart function, prone position ≥2 h; 5 continuous pain, medication, physical therapy and other conservative treatment without significant improvement ; 6 vertebral lesions dominated by osteolytic destruction; 7 expected survival time> 3 months; 8 primary tumor or metastatic vertebral body obtained pathology report is adenocarcinoma. Statistics of primary tumor focus and metastasis to the spine segment, vertebroplasty under DSA or CT, injection of polymethylmethacrylate (PMMA), also known as 1.5 ~ 5.0 ml of bone cement, vertebral segment 1 ~ 6 sections. Visual analogue scale (VAS) score and VAS score after surgery were performed before surgery. Results All 84 patients underwent surgery successfully. The average score of preoperative VAS (6.48 ± 1.77) was decreased to (2.75 ± 1.52) postoperatively (P <0.01). Preoperative mild pain was found in 3 patients, There were 33 cases of moderate pain, 35 cases of severe pain, 57 cases of postoperative mild pain, 11 cases of moderate pain and 3 cases of severe pain. There were significant differences in the number of cases before and after operation (P <0.01) , Pain relief drugs or stop. Conclusions Vertebroplasty is an effective method to treat metastatic adenocarcinoma of the spine. It can reduce the use of analgesic drugs in cancer patients and enhance the patients’ self-care ability.