摘要
目的评估伴随或不伴相关神经压迫症状的硬膜外间隙受累椎体转移瘤患者行经皮椎体成形术的可行性、安全性以及疗效。方法回顾性分析行经皮椎体成形术的硬膜外受累椎体转移瘤患者36例,每例各有一个椎体病变破坏椎体后缘或肿瘤侵犯硬膜外,10例伴有脊髓或马尾神经受压的症状。本组治疗36例患者共59个患椎。通过观察术后是否发生不良事件进行安全性评价;观察患者手术前后的疼痛程度变化进行镇痛疗效评估。有效疼痛缓解的定义为术后视觉模拟评分(visual analogue scale,VAS)较术前疼痛评分改善至少50%。随访评估分别在手术后1d,1周,1、3和6个月进行。结果患者有效疼痛缓解率术后1d及1周为97.2%(35/36),术后1个月为88.2%(30/34),术后3个月为84.4%(27/32),术后6个月为75.0%(21/28)。骨水泥渗漏发生率为59.3%(35/59)。所有患者无临床并发症发生。结论经皮椎体成形术对于累及硬膜外间隙的疼痛性椎体转移瘤是一种安全有效的微创治疗方式,无论有或无相关神经压迫症状,其不应被视为经皮椎体成形术的禁忌证。
Objective To evaluate the feasibility,safety,and efficacy of PVP in pain management of spinal metastasis with epidural involvement.Methods Thirty-six patients with spinal metastatic disease were retrospectively analyzed,who presented each with one vertebral lesion with destruction of the posterior vertebral body wall or epidural extension of tumor.Among these patients,ten had signs of spinal cord or cauda equina compression.Fifty-nine vertebrae in 36 patients were treated in this group.Procedural safety was evaluated by any post-procedure adverse events.The PVP analgesic efficacy was evaluated by follow-up neurological examination.The effective pain relief was defined as at least 50% improvement in pain score（visual analogue scale,VAS）as compared with pre-procedure baseline.Follow-up assessments were performed at 1 day;1 week;1,3,and 6 months after the procedure.Results Analgesic efficacy in survival patients was rated at 97.2%（35/36）at 1 day and 1 week,88.2%（30/34）at 1 month,84.4%（27/32）at 3 months,and 75.0%（21/28）at 6 months after procedure.Leakage of PMMA was detected in 59.3%（35/59）treated vertebrae.No systemic complications were observed in all treated patients.Conclusions PVP is a feasible,safe,effective and minimal invasive procedure for painful spinal metastasis with epidural involvement.Epidural involvement with or without neurological signs of spinal cord or cauda equina compression should not be a contraindication to performance of PVP in patients with spinal metastasis.
出处
《中华临床医师杂志（电子版）》
CAS
2012年第3期65-69,共5页
Chinese Journal of Clinicians(Electronic Edition)
关键词
椎体成形术
疼痛
脊柱转移瘤
介入诊疗
Vertebroplasty
Pain
Spinal metastasis
Interventional procedures
