摘要
[目的]探讨单侧椎弓根外入路经皮椎体成形（percutaneousv ertebroplasly，PVP）和后凸成形术（percutaneous kyphoplasty，PKP）治疗高位胸椎转移性肿瘤柞体破坏的可行性和安全性，评价临床疗效。[方法]2008年3月，1例T1～3肺癌转移，男性，59岁，诊断肺瘾8个月，上胸椎及左侧肩部剧烈疼痛6个月，药物镇痛效果不佳，无手术可能，使用国产PVP和PKP工具包，采用局部麻醉，在透视引导下单侧椎弓根外入路完成T2和T3椎体强化。随访观察治疗效果。[结果]手术过程顺利，T3和T2椎体分别进行PKP和PVP治疗，T1椎体因患者不能继续耐受而放弃。T3椎体PKP时间57min，骨水泥填充量1．9ml，T2椎体PVP时间49min，骨水泥填充量1．5ml。T2椎体左侧椎弓根破坏骨水泥外漏但无临床症状，无其它并发症发生、患者术后5d出院。术前、术后2d和3个月随访时VAS评分分别为10分、3分和6分．使用镇痛药物可控制疼痛．[结论]单侧椎弓根外入路PVP和PKP是治疗高位胸椎转移件肿瘤的安全有效方法，能够有效缓解疼痛。
[ Objective] To explore the feasibility and safety of percutaneous kyphoplasty （PKP） and percutaneous vertebroplasty （PVP） treating osteolytic lesions of high thoracic vertebra with metastasis by one side extrapedicular approach, and to assess the clinical result of minimally invasive technique. [ Methods] In March 2008, one patient （ male, 59 years old） with T1-3 vertebral metastases of lung cancer diagnozed 8 months ago was selected. The symptoms included extremely severe pain in upper thoracic spine and left should. The analgesic effect was limited for more than 6 months. There was no operative option. Domestic PKP and PVP tool systems were used in local anaesthesia. Under fluoroscopic guidance, T2 and T3 vertebral augmentation were separately completed by single side extrapedicular approach PKP and PVP. Clinical results were followed up and observed. [ Results ] The procedure was performed smoothly. T3 and T2 vertebrae were differently treated by PKP and PVP. T1 received no treatment because of patient＇s intolerance. The operative time of T3 vertebral PKP was 57 minutes. The volume of injected bone cement was 1.9ml. The operative time of T2 vertebral PVP was 49 minutes. The volume of injected bone cement was 1.5ml. Extravertebral leakage of the polymethylmethacrylate （PMMA） into the paravertebral itssue was found without clinical symptom, because osteolysis occurred in the left pedicle of T2 vertebra. There was no other complication. The patient was discharged 5 days after operation. The preoperative, 2 days and 3 months postoperative follow - up VAS scores were 10, 3 and 6. The patient＇ s markedly pain could be controlled by analgesia. [ Conclusion] One side approach percutaneous kyphoplasty is a safe and effective technique for treatment of high thoracic vertebral metastasis with markedly relief of pain.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2010年第1期34-37,共4页
Orthopedic Journal of China
关键词
经皮椎体后凸成形术
经皮椎体成形术
胸椎
肿瘤转移
percutaneous kyphoplasty
percutaneous vertebroplasty
thoracic vertebra
metastsis
