经皮椎体后凸成形分次和温度梯度灌注骨水泥治疗胸腰椎转移性肿瘤.doc

经皮椎体后凸成形分次和温度梯度灌注骨水泥治疗胸腰椎转移性肿瘤张 凡，杨惠林，管华清苏州大学附属第一医院骨科，江苏省苏州市 215006Percutaneous vertebroplasty and bone cement perfusion at different times and temperature gradients for metastatic tumor in thoracic lumbar vertebraeZhang Fan, Yang Hui-lin, Guan Hua-qingDepartment of Orthopedics, First Affiliated Hospital, Soochow University, Suzhou 215006, Jiangsu Province, China摘要 背景：经皮椎体后凸成形治疗已被广泛用于椎体骨质疏松性压缩性骨折，现在亦被用于治疗椎体转移性肿瘤。目的：评估采用经皮椎体后凸成形分次和温度梯度灌注骨水泥治疗胸腰椎转移性肿瘤效果。方法：回顾性分析经皮椎体后凸成形分次和温度梯度灌注骨水泥治疗胸腰椎转移性肿瘤病例共24例38椎，分为椎体压缩1/4组9例11椎和椎体压缩 1/4组15例27椎。在C臂机透视定位下行经皮椎体后凸成形，采用分次灌注、温度梯度灌注方法注射骨水泥。以目测类比评分及Owestry功能障碍指数评估经皮椎体后凸成形分次和温度梯度灌注骨水泥治疗前后疼痛缓解情况，日常功能恢复情况，治疗椎的高度变化。随访时间为12-56个月。结果与结论：24例患者均成功完成经皮椎体后凸成形分次和温度梯度灌注骨水泥治疗。平均单个胸椎内注射骨水泥(41) mL，单个腰椎内注射骨水泥(51) mL。治疗后复查X射线片见骨水泥分布良好，无神经根损伤或脊髓压迫症状。两组患者治疗后椎体高度显著高于治疗前(P 0.05)。所有患者治疗后1 d、治疗后1个月及末次随访时目测类比评分、功能障碍指数值均显著低于治疗前(P 0.05)；两组相同时间点目测类比评分、功能障碍指数评分的改变值差异无显著性意义。结果表明经皮椎体后凸成形分次和温度梯度灌注骨水泥治疗胸腰椎转移性肿瘤，可减少骨水泥渗漏的发生，不论肿瘤转移椎体有无明显压缩，均能迅速缓解疼痛，是治疗椎体转移肿瘤的有效方法。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：窗体顶端关键词 ： 植入物； 脊柱植入物； 经皮椎体后凸成形术； 脊柱肿瘤； 转移； 压缩； 无明显压缩； 疗效比较； Abstract： BACKGROUND: Percutaneous vertebroplasty has been extensively applied in treatment of osteoporotic vertebral compression fractures, and now it is also used in spinal metastatic tumor. OBJECTIVE: To evaluate the effectiveness of percutaneous vertebroplasty for metastatic tumor of thoracic lumbar vertebrae by bone cement perfusion at different times and temperature gradient. METHODS: A total of 24 cases (38 vertebrae) of metastatic tumor receiving percutaneous vertebroplasty and bone cement perfusion at different times and temperature gradient were reviewed retrospectively. All patients were classified into group A (11 vertebrae in 9 cases) featured with apparent vertebral compression ( 1/4) and group B (27 vertebrae in 15 cases) of no obvious compression ( 1/4). The percutaneous vertebroplasty was conducted with C-arm fluoroscopy positioning. Bone cement was injected by perfusion at different times and temperature gradient method. Visual Analogue Scales and Owestry Disability Index were recorded to assess pain alleviation and functional restoration before and after bone cement injection at different times and temperature gradient. The height of treated vertebrae was also analyzed. Follow-up was performed for 12 to 56 months. RESULTS AND CONCLUSION: All 24 patients successfully underwent percutaneous vertebroplasty and bone cement perfusion at different times and temperature gradient. Bone cement (41) mL was averagely injected into each thoracic vertebra. Bone cement (51) mL was injected into each lumbar vertebra. Postoperative recheck radiographs revealed good bone cement distribution, no nerve root injury or spinal compression occurred. Vertebral height was significantly higher posttreatment compared with pretreatment in both groups (P 0.05). Visual Analogue Scales and Owestry Disability Index scores were significantly lower at 1 day, 1 month after treatment and during final follow-up compared with preoperation in all patients (P 0.05). No significant difference in Visual Analogue Scales and Owestry Disability Index scores was detected between two groups at the same time point. Results suggested that percutaneous vertebroplasty and bone cement perfusion at different times and temperature gradient for metastatic tumor of thoracic lumbar vertebrae could reduce the occurrence of bone cement leakage, and could ease the pain quickly for apparent and non-apparent compressed tumor metastatic vertebrae. It is an effective method to treat metastatic tumor of vertebrae.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： spine; bone neoplasms; vertebroplasty; 窗体底端 中图分类号:R318 通讯作者: 杨惠林，主任医师，教授，博士生导师，苏州大学附属第一医院骨科，江苏省苏州市 215006 作者简介: 张凡，男，1989年生，江苏省兴华市人，汉族，苏州大学在读硕士，主要从事脊柱、关节疾病的基础与临床研究。引用本文: 张 凡,杨惠林,管华清. 经皮椎体后凸成形分次和温度梯度灌注骨水泥治疗胸腰椎转移性肿瘤J. 中国组织工程研究, 2014, 18(26): 4206-4211. Zhang Fan,Yang Hui-lin,Guan Hua-qing . Percutaneous ve