摘要:
目的:探讨经皮成形术(PVP)联合放疗治疗脊椎骨转移瘤的方法及疗效.方法:对26例经病理学证实的42个病变椎体行PVP.骨水泥按粉、液、对比剂3:2:1比例配制.胸腰骶椎区均采用经椎弓根或椎体后外侧穿刺,在确定穿刺到位并无椎管内渗漏后,将骨水泥快速灌注至椎体内.灌注量为胸椎平均4.6ml,腰椎平均5.4ml,骶椎平均5.5ml.术后观察患者疼痛缓解程度,并于当日、1个月CT检查注射椎体.放疗在PVP后第3～4天开始,采用60C0照射,2～3Gy/次,总量35～45Gy/3～4周.结果:穿刺成功率100%本组26例单侧穿刺32个椎体,双侧穿刺10个椎体.CT检查骨水泥周围组织渗漏2例,但均未出现临床症状.26例放疗过程顺利.PVP后止痛有效率为80.8%(21/26),联合放疗后,止痛有效率上升至96.2%(25/26).随访4～10个月,止痛有效率在10个月内为88.5%(23/26).结论:PVP有靶区硬度压强和快速缓解疼痛的作用,放疗能强化对肿瘤的抑制,从而达到提高疗效的目的.
Abstract:
Objective :To discuss the methodology and efficacy of percutaneous vertebroplasty combined with radiotherapy for the treatment of spinal vertebra metastases. Methods :Twenty-six pabents underwent percutaneous vertebroplasty on fouty-two segment levels with DSA guidance, bone cement was made accoding to the ratio power/liquid/contrast as 3:2:1 in injecting paste form. The puncturation through pedicle of vertebral arch and lateral posterior body of vertebra was both adopted in thoracic and lumbosacral vertebrae site. After making sure that the puncture was completed and there was no leakage in vertebral lx >dy, the lx >ne cement was poured into vertebral lx >d y quickly. The average priming volume of thoracic spine was 4.6m1, the lumbar spine was 5.4m1 and the sacral spine S.SmI. The easement of pain was observed and CT scaning was carried out on the day and one month laterter operation. Radiotherapy was performed 3-4 days after PVP with external radiation of 6 for 3-4Gy one fraction to a total dose 35-45Gy/3-4 weeks. Results :The successful puncture of PVP was ob- tamed in 100%. The leakage of bone cement occurred in 2 cases by CT scaning, but no clinical tomplaint was found. Radiotherapy was performed successfully in 24 patients. The rate of pain relief was 80.8% (21/26) after PVP, and it increased to 96.2% (25/26) when combined with radiotherapy. The follow-up was from 4 10 months and the rate of pain relief reached 88.5%(23/26) in 10 months. Conclusions : Percutaneous vertebroplasty can strengthen the target and relief pain quickly. It can guarantee the feasibility and safty of radiotherapy sequent in the treatment of intensive patient. Radiotherapy strengthen the inhibition of tumor, so as to increase therapeutic effect.
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