125i放射性粒子植入联合椎体成形椎弓根钉棒内固定治疗胸腰椎转移瘤

125I 放射性粒子植入联合椎体成形椎弓根钉棒内固定治疗胸腰椎转移瘤 刘俊良，高国勇，镇万新，刘 洋，杨大志，林二虎 暨南大学第二临床医学院、深圳市人民医院脊柱外科，广东省深圳市 518020 Iodine-125 radioactive seed implantation combined with vertebroplasty and nail-rod fixation for thoracolumbar metastatic tumors Liu Jun-liang, Gao Guo-yong, Zhen Wan-xin, Liu Yang, Yang Da-zhi, Lin Er-hu Second Clinical Medical College of Jinan University, Department of Spinal Surgery, Shenzhen Municipal Peoples Hospital, Shenzhen 518020, Guangdong Province, China 摘要 背景：目前椎体成形和椎管减压内固定是治疗脊柱转移瘤的常用方法， 125I 放射性粒子植入控 制肿瘤的临床疗效也已得到研究证实，但是关于上述 3 种方法的综合治疗的临床研究很少。 目的：比较采用 125 I 放射性粒子植入联合椎体成形椎弓根钛合金钉棒内固定与单纯椎体成形 椎弓根钛合金钉棒内固定治疗胸腰椎转移瘤在疼痛控制、内固定后体力恢复状态及脊髓神经功 能改善等方面的差异，评价 125 I 放射性粒子植入联合治疗方案的临床应用价值。 方法：选择 2009 年 10 月至 2013 年 3 月于深圳市人民医院脊柱外科手术治疗的胸腰椎转移 瘤患者，以脊柱后路胸腰椎钛合金钉棒置入内固定系统，并根据其是否联合 125I 放射性粒子植 入分为实验组与对照组。观察记录各组钛合金钉棒内固定前及内固定后 2 周，内固定后 1，6，12 个月的脊髓神经功能改善情况。 结果与结论：所有患者均获得随访，随访时间 7-29 个月，平均 15.8 个月，脊柱后路胸腰椎 钛合金钉棒内固定系统未发生松动断裂，骨水泥分布良好，实验组患者未发现放射性粒子移位 及放射性脊髓损伤，随访期内未见病椎局部肿瘤明显复发扩散。实验组患者内固定后目测类比 疼痛评分、行为状态评分较对照组明显改善(P 0.05)。说明 125I 放射性粒子植入联合椎体成形椎弓根钛合金钉棒内固定治疗脊柱转移瘤缓解癌性疼痛的效 果更为明显。 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨 科；组织工程 全文链接： 关键词 ： 植入物； 脊柱植入物； 脊柱转移瘤； 125I 放射性粒子 ； 椎体成形； 内固定； 临床疗 效； 疼痛； 钛合金钉棒； Abstract： BACKGROUND: At present, vertebroplasty and spinal canal decompression are common methods for treatment of metastatic spinal tumors. Iodine-125 (125I) radioactive seed implantation has been shown to control the tumor. However, there were few clinical studies on combined therapy using above-mentioned methods. OBJECTIVE: To compare the differences of 125I radioactive seed implantation combined with vertebroplasty and titanium alloy nail-rod fixation and vertebroplasty combined with titanium alloy nail-rod fixation for treating thoracolumbar metastases on pain control, general performance and improvement of the spinal cord function, and to evaluate clinical value of 125I radioactive seed implantation combined with therapeutic plans. METHODS: Thoracolumbar metastases patients undergoing titanium alloy nail- rod fixation were selected in the Department of Spinal Surgery, Shenzhen Municipal Peoples Hospital in China from October 2009 to March 2013. They were assigned to experimental and control groups according to with or without 125I radioactive seed implantation. Improvement in neurological function was observed before and 2 weeks, 1, 6, and 12 months after titanium alloy nail-rod fixation in both groups. RESULTS AND CONCLUSION: All patients were followed up for 7 to 29 months, averagely 15.8 months. There was no loosening of titanium alloy nail-rod fixation and the position of bone cement was good. No seed migration or radioactive spinal cord injury was observed. No relapse or diffusion in the surgical site was observed during follow up. Visual Analogue Scale and Karnofsky Performance Status scores were higher in the experimental group than in the control group (P 0.05). Results indicated that 125I radioactive seed implantation combined with vertebroplasty and titanium alloy nail-rod fixation for treatment of metastatic spinal tumors showed obvious outcomes in relieving cancer pain. 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨 科；组织工程 全文链接： Key words： bone neoplasms; bradioisotopesb vertebroplasty; pain; 中图分类号: R318 基金资助: 广东省医学科学技术研究基金项目(A2012567) 通讯作者: 高国勇，硕士，主任医师，暨南大学第二临床医学院、深圳市人民医院脊柱外科， 广东省深圳市 518020 作者简介: 刘俊良，男，1982 年生，广东省兴宁市人，汉族，2012 年暨南大学毕业，硕士， 主治医师，主要从事脊柱肿瘤、微创介入、脊柱退行性疾病方面的研究。 引用本文: 刘俊良,高国勇 ,镇万新等 . 125I 放射性粒子植入联合椎体成形椎弓根钉棒内固定治疗胸腰椎转移瘤J. 中国组织工程研究, 2014, 18(26): 4200-4205. Liu Jun-liang,Gao Guo-yong,Zhen Wan-xin et al. Iodine-125 radi