摘要
目的 回顾分析微创穿刺Intrabeam（R）术中放疗联合骨水泥强化治疗脊柱转移瘤的安全性和近期临床疗效.方法 收集2013年8月全2015年5月间采用微创穿刺Intrabeam（R）术中放疗联合骨水泥强化治疗的32例转移性脊柱肿瘤患者的病历资料,男13例,女19例;年龄28～70岁,平均47.9岁.原发肿瘤：乳腺癌15例、肺癌8例、肝癌3例、其他6例.共治疗42个瘤椎,单节段24例、双节段6例、三节段2例.主要临床表现为胸腰背部局部疼痛（32/32,100％）.X线片显示骨破坏的9例（9/32,28.13％）,其余表现为X线片未见骨破坏仅MRI显示转移灶者.手术方法为＂C＂型臂或＂O＂型臂X线机监视下,在经皮椎体成形或后凸成形术灌注骨水泥前行Intrabeam（R）术中放疗,放疗后以骨水泥强化瘤椎.采用视觉疼痛模拟评分（visual analogue scale,VAS）评价手术前后及随访期间的疼痛缓解情况,影像学检查评价病椎局部破坏和术后改善状况.生活质量评价采用EORTC QLQ-BM22量表.结果 手术过程均顺利,术中放疗剂量（9.39±3.32） Gy,平均术中放疗时间为每节段4 min50 s.随访至2015年8月31日,随访时间平均11.2个月（3～15个月）,失访1例,死亡2例,靶椎复发、进展2例.瘤椎局部控制率为95.12％.患者局部疼痛由术前VAS评分（5.46±2.37）分减轻至术后第3天的（2.92±0.92）分,差异有统计学意义,并能维持至末次随访.EORTC QLQ-BM22骨转移瘤生存质量评分显示患者在疼痛部位、程度和功能方面均较术前获得明显改善,社会心理方面的影响则变化不大.结论 微创穿刺术中放疗联合骨水泥椎体强化治疗胸腰椎脊柱转移瘤,能安全有效控制肿瘤进展和缓解疼痛,并明显改善患者生活质量.
Objective To analyze the safety and short-term clinical results of intraoperative radiotherapy （IORT, Intrabeam（R）） during minimally invasive vertebral augmentation by bone cement for spinal metastases.Methods From August 2013 to May 2015, 42 metastatic vertebrae （32 patients） were treated using Intrabeam（R） IORT combined with minimally invasive vertebral augmentation in our department.There were 13 males （mean age 47.9, 28-70 years）.The primary tumors were composed of breast cancer （15）, lung cancer （8）, liver cancer （3） and others （6）.There were 24 patients with single vertebra segment involvement, 6with double segments and 2 with triple segments.The main clinical manifestations included thoracic back local pain （32/32,100%）, X-ray, CT or/and MRI examination may indicate that the vertebral bodies have different sizes of metastases, with or without the different degree of osteolytic bone lesion.Intrabeam（R） IORT was executed before bone cement perfusion during percutaneous vertebroplasty or kyphoplasty guided by C arm or O arm device.Following IORT, bone cement augmentation was performed for tutorial vertebra.The items, including VAS score for pain evaluation, iconography image for targeted vertebrae and EORTC QLQBM22 questionnaire for quality of life in patients with bone metastases, were analyzed before operation, and at the 3rd day, the 3nd month, the last follow-up after operation.Results Operations had been undergone smoothly for this group of patients.The prescribed dose of 9.39±3.32 Gy was delivered to these patients over approximately 4 min 50 sec every vertebral segment.The mean follow-up was 11.2 months （3～15months）, with 1 loss of follow-up, 2 deaths and 2 recurrences.The local control rate was 95.12%.The local pain was significantly reduced from 5.46±2.37 pre-operation to 2.92±0.92 on the 3rd day after operation, which maintained until the end of the follow-up.According to EORTC QLQ BM22 questionnaire, patients obtained significant improvement in pain location, severity, and function.However, no significant alleviation in social psychology was reported.Conclusion Intrabeam（R） IORT combined with minimally invasive bone cement augmentation in the treatment of thoracic and lumbar spinal metastases can control tumor progression and ease pain safely and effectively, thus improves the quality of life.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2016年第4期215-223,共9页
Chinese Journal of Orthopaedics
基金
中山大学临床研究5010计划培育项目（2015001）
国家自然-广东联合基金（U1301223）
