经皮椎体成形术治疗胸腰椎转移瘤的疗效分析
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摘要
目的探讨经皮椎体成形术在治疗胸腰椎椎体转移瘤的临床应用价值。方法对31例胸腰椎椎体转移瘤97个椎体行经皮椎体成形术,术后1周、3个月、6个月、12个月分别就疼痛缓解程度应用视觉模拟评分法(VAS)进行评估分级,采用日常生活自理能力(ADL)量表对治疗后患者生活质量进行评估。术后1周测骨水泥在椎体的充盈情况,评估其和疼痛缓解的相关性。结果 97个椎体穿刺全部成功,17个椎体发生骨水泥漏,但均未出现临床症状。术后各期疼痛缓解率分别为93.5%、90.3%、89.7%、85.7%。7例椎体充盈率不足1/3的患者术后1周疼痛缓解优良3例,优良率42.9%。24例充盈率大于1/3的患者疼痛缓解优良21例,优良率87.5%,差异具有统计学意义(P=0.027)。患者生活质量ADL评分,手术前(64.8±8.4)分,术后1年(86.7±8.9)分,差异有统计学意义(t=8.163,P=0.004)。结论经皮椎体成形术是目前治疗胸腰椎椎体转移瘤的有效方法,其止痛作用与骨水泥在病椎椎体的充盈率相关,可全面改善患者的生存质量。
Objective To investigate the clinical value of percutaneous vertebroplasty treatment for patients of thoracic and lumbar metastatic tumor.Methods Totally 31 patients(97 vertebral bodies)were treated by PVP.We measured the percent of cement filling 1 week postoperative to assess its relation with pain relief.Follow-up of pain relief grade and life quality was respectively evaluated with VAS(Visual Analog Scale)and ADL(activity of daily life)questionnaire at 1week,3,6 and 12 months postoperative.Results 97 vertebrae were all infused successfully without symptomatic complications despite of cement leakage in 17 of them.The rate of postoperative pain relief was respectively 93.5%,90.3%,89.7%,and 85.7% at 1 week,and 3,6,and 12 months.3 of 7 insufficient filling patients(less than 1/3 of the vertebral volume) had a good result of pain relief while 21 of 24 sufficient filling patients(more than 1/3 of the vertebral volume) gained the same outcome with statistical significance(P=0.027).Total ADL score of life quality improved to 86.7±8.9 from 64.8±8.4 during the 1-year follow-up(t=8.163,P=0.004).Conclusion For patients who are suffering from thoracic and lumbar metastatic tumor,percutaneous vertebroplasty(PVP) is an effective procedure in pain management and life quality improvement.The analgesic efficacy of PVP depended upon cement efficacy in local vertebra.
Objective To investigate the clinical value of percutaneous vertebroplasty treatment for patients of thoracic and lumbar metastatic tumor.Methods Totally 31 patients(97 vertebral bodies)were treated by PVP.We measured the percent of cement filling 1 week postoperative to assess its relation with pain relief.Follow-up of pain relief grade and life quality was respectively evaluated with VAS(Visual Analog Scale)and ADL(activity of daily life)questionnaire at 1week,3,6 and 12 months postoperative.Results 97 vertebrae were all infused successfully without symptomatic complications despite of cement leakage in 17 of them.The rate of postoperative pain relief was respectively 93.5%,90.3%,89.7%,and 85.7% at 1 week,and 3,6,and 12 months.3 of 7 insufficient filling patients(less than 1/3 of the vertebral volume) had a good result of pain relief while 21 of 24 sufficient filling patients(more than 1/3 of the vertebral volume) gained the same outcome with statistical significance(P=0.027).Total ADL score of life quality improved to 86.7±8.9 from 64.8±8.4 during the 1-year follow-up(t=8.163,P=0.004).Conclusion For patients who are suffering from thoracic and lumbar metastatic tumor,percutaneous vertebroplasty(PVP) is an effective procedure in pain management and life quality improvement.The analgesic efficacy of PVP depended upon cement efficacy in local vertebra.
引文
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[6]刘绪立,雷伟,郑金,等.椎体模型内模拟注射PMMA的流动及分布规律[J].第四军医大学学报,2007,28(2):143-145.
[7]李健,黄海,潘永谦,等.经皮穿刺椎体成形术治疗胸椎转移瘤[J].中国矫形外科杂志,2011,19(11):912-917.
[2]Burton AW,Reddy SK,Shah HN,et al.Percutaneous ver-tebroplasty:a technique to treat refractory spinal pain inthe setting of advanced metastatic cancer:a case series[J].J Pain Symptom Manage,2005,30(1):87-95.
[3]Lips P,van Schoor NM.Quality of life in patients withosteoporosis[J].Osteoporos lnt,2005,16(5):447-455.
[4]Chi JH,Gkaslan ZL.Vertebroplasty and kyphoplasty forspinal metastases[J].Curr Opin Support Palliat Care,2008,2(1):9-13.
[5]Urrutia J,Bono CM,Mery P,et al.Early histologic chan-ges following polymethylmethacrylate injection(vertebro-plasty)in rabbit lumbar vertebrae[J].Spine(Phila Pa1976),2008,33(8):77-82.
[6]刘绪立,雷伟,郑金,等.椎体模型内模拟注射PMMA的流动及分布规律[J].第四军医大学学报,2007,28(2):143-145.
[7]李健,黄海,潘永谦,等.经皮穿刺椎体成形术治疗胸椎转移瘤[J].中国矫形外科杂志,2011,19(11):912-917.