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目的评估~(125)I放射性粒子植入联合椎体后凸成形术(percutaneous kyphoplasty,PKP)在治疗胸腰椎转移瘤中的应用价值。方法选取2009年1月至2013年12月,拟行经皮椎体成形术的胸腰椎转移瘤患者,对其是否联合~(125)I放射性粒子植入术分为研究组与对照组。观察并记录术前及术后2周、1、3、6、12个月的VAS评分(visual analogue scale)及KPS评分(karnofsky performance score),比较两组各项指标的变化情况。结果研究组21例,对照组25例,手术均顺利完成,无围手术期死亡病例。所有病例均随访12~60个月,平均(37.5±15.9)个月,未发现骨水泥渗漏,研究组病例未发现放射性粒子移位或放射性脊髓损伤。研究组及对照组术前VAS评分分别为8.44±1.32、8.7±1.83,两组术后2周、1、3、6、12个月VAS分别为2.79±3.46、3.21±253、2.96±2.16、3.08±2.03、3.17±1.24及4.23±2.78、3.42±2.21、3.63±1.76、3.58±2.53、3.62±3.12,手术前后比较有统计学意义(P<0.05),且研究组较对照组改善更明显(P<0.05),说明联合~(125)I放射性粒子植入止痛效果更明显。研究组和对照组术前KPS分别为55.0±11.7及60.9±16.4,术后2周,1、3、6、12个月分别为85.7±12.5、89.7±10.6、81.96±14.4、82.1±11.3、81.3±11.2及91.2±12.7、90.4±13.1、88.6±13.3、86.8±12.3、83.6±13.2,术后KPS分别较术前明显改善,但在术后2周、1、3、6、12个月各时间点的KPS评分两组间差异无统计学意(P>0.05),说明手术对于患者体力恢复的作用无明显差别。结论 ~(125)I放射性粒子植入术联合PKP治疗脊柱转移瘤,在临床操作上安全可行,能达到缓解癌性疼痛、局部肿瘤控制、重建脊柱稳定性的作用,短期疗效可靠,为脊柱转移瘤患者提供了一种新的有效治疗方法。在疼痛控制方面,联合~(125)I放射性粒子植入术较单纯椎体成形术效果更佳。
Objective To evaluate the value of 125I radioactive seed implantation combined with percutaneous kyphoplasty (PKP) in the treatment of thoracolumbar metastases. Methods From January 2009 to December 2013, patients with thoracolumbar metastases who underwent percutaneous vertebroplasty were divided into study group and control group according to whether they were combined with 125I radioactive seed implantation. The visual analogue scale and Karnofsky performance score were observed and recorded before and 2 weeks, 1, 3, 6 and 12 months after operation. The changes of each index were compared between the two groups. Results 21 cases of study group, 25 cases of control group, the operation was completed successfully, no perioperative deaths. All cases were followed up for 12 to 60 months, with an average of (37.5 ± 15.9) months. No leakage of cement was found. No radioactive particle transposition or radioactive spinal cord injury was found in the study group. The preoperative VAS scores of the study group and the control group were 8.44 ± 1.32 and 8.7 ± 1.83 respectively. The VAS scores of the two groups were 2.79 ± 3.46,3.21 ± 253,2.96 ± 2.16 at 2, 3, 6 and 12 months after operation, 3.08 ± 2.03,3.17 ± 1.24 and 4.23 ± 2.78,3.42 ± 2.21,3.63 ± 1.76,3.58 ± 2.53,3.62 ± 3.12 respectively. There was statistical significance before and after operation (P <0.05), and the improvement of the study group was more obvious than that of the control group (P <0.05), indicating that combined 125I radioactive particles implantation analgesic effect is more obvious. The preoperative KPS of the study group and the control group were 55.0 ± 11.7 and 60.9 ± 16.4, respectively, and were 85.7 ± 12.5, 89.7 ± 10.6, 81.96 ± 14.4 and 82.1 ± 11.3 at 2 weeks, 1, 3, 6 and 12 months after operation, 81.3 ± 11.2 and 91.2 ± 12.7, 90.4 ± 13.1, 88.6 ± 13.3, 86.8 ± 12.3 and 83.6 ± 13.2, respectively. Postoperative KPS were significantly improved compared with preoperative, but at 2 weeks, 1, 3, 6 and 12 months There was no significant difference between the two groups in the KPS score at each time point (P> 0.05), indicating that there was no significant difference between the two groups in the operation. Conclusion 125I radioactive seed implantation combined with PKP in the treatment of spinal metastases is safe and feasible in clinical practice. It can relieve the pain of cancer, control local tumors and reconstruct the stability of the spine. The short-term curative effect is reliable, Tumor patients provide a new and effective treatment. In pain control, combined 125I radioactive particle implantation is more effective than simple vertebroplasty.