摘要
目的探讨DSA引导下射频消融术(radiofrequency ablation,RFA)联合经皮骨成形术(pecutaneous osteo-plasty,POP)治疗椎体外转移性骨肿瘤的手术方法及临床疗效。方法回顾性分析38例(54个病灶)行RFA联合POP治疗的椎外骨转移性肿瘤患者资料,年龄23～75岁,平均(52.6±12.2)岁。共54个转移灶得到治疗,其中髂骨24处、髋臼21处、股骨7处、坐骨1处、胫骨1处。所有患者至少随访3个月,通过术前、术后视觉模拟评分(vis-ual analog scale,VAS)、止痛药服用剂量的变化以及运动功能的改善情况评价临床效果。结果 38例手术均获得成功。术后24 h VAS评分由术前平均(7.1±1.5)分降至术后(2.2±2.0)分,术后3个月降至(1.6±1.8)分,术后6个月降至(1.3±1.8)分。术后7例(18.4%)疼痛完全缓解,25例(65.8%)完全无需止痛药,10例(26.3%)止痛药用量减少或止痛药级别降级,2例(5.3%)维持原剂量,1例(2.6%)使用止痛药级别升级。33例行走困难者中20例(60.6%)术后行动功能改善,其中4例可正常行走;12例(36.4%)仍然行走困难;1例(3%)行动不便加重,稍微活动即疼痛难忍。术后患者中位生存时间为15个月,1年生存率为68.9%,2年生存率为27.3%。8例(21.1%)发生肿瘤周围软组织骨水泥渗漏,但无明显临床症状,1例(2.6%)发生皮肤灼伤。结论 DSA引导下行RFA联合POP治疗椎外转移性骨肿瘤临床效果良好、创伤小、并发症少,可以明显提高患者生存质量。
Objective To discuss the technical points, safety and clinical efficacy of DSA guided radiofrequency abla- tion（RFA） therapy combined with percutaneous ostetoplasty （POP） in treating painful extraspinal bone metastases. Meth- otis Thirty eight patients, median age of 52.6 ± 12.2 years old （ range 23 - 75 years） with a total of 54 extraspinal bone metastases, were treated with RFA combined with POP. The lesions were located at ilium（n = 24）, acetabulum（ n = 21 ）, femora（ n =7）, ischium（ n =4） and tibia（ n = 1 ）. All the patients were followed for at least 3 monthes. Clinical evaluation was based on clinical conditions such as the change of visual analog scale （ VAS）, the amount of analgesic medicine and functional recovery before and immediately after the therapy and during the follow up. Results Technical success a- chieved in all patients. Mean VAS scores dropped from 7.1±1.5 （ range 4 - 10 ; before therapy） to 2.2 ± 2. 0（ range 0 - 9 ; 24 h after therapy）, 1.6± 1.8 （ range 0 - 6 ; 3 month after therapy）, 1.3 ± 1.8 （ range 0 - 7 ; 6 month after therapy）. After RFA combined with POP therapy,the pain was complete remission in 7 cases（ 18.4% ）. Twenty five cases （65.8%） didn＇ t need analgesic medicine anymore. 10 cases （26.3 % ） needed less amount of analgesic medicine than before. The walking function was improved in 20 cases. The median survival time was 15 months. The one - year survival rates was 68. 9% and two -year survival rates was27.3%. Major complications were PMMA leakage in 8 cases and skin bum in lcase. Conclusion DSA guided RFA combined with POP as a less invasive and safe therapy has high clinical efficacy to improve the living quality of the patients with painful extraspinal bone metastases.
出处
《临床放射学杂志》
CSCD
北大核心
2012年第12期1777-1781,共5页
Journal of Clinical Radiology
关键词
经皮骨成形术
射频消融术
骨转移瘤
椎外
Perctutaneous osteoplasty Radiofrequeney ablation Bone metastases Extraspinal bone
