经皮椎体成形术联合低温等离子消融治疗胸腰椎转移瘤的临床研究

　　[摘要] 目的 探讨椎体成形联合低温等离子消融技术治疗胸腰椎转移瘤的临床效果。 方法 选取2010年1月～2015年6月于浙江金华广福医院骨科就诊且临床影像和病理确诊为恶性肿瘤胸腰椎转移瘤患者20例，行局麻下经皮微创椎体成形术联合低温等离子消融治疗。比较患者术前、术后视觉模拟评分（VAS），观察CT及X线片结果。 結果 20例手术均获得成功，术后2 h佩戴腰围带下地活动，随访12～30个月，平均18个月，术后患者胸腰部疼痛明显减轻，VAS评分由术前（6.9±0.9）分降至术后（1.6±0.8）分（P < 0.05），生活质量得到显著提高，复查CT及X线片提示病灶骨水泥填充满意，无渗漏。 结论 经皮椎体成形术联合低温等离子消融术对于局限于椎体的溶骨性转移病灶恶性肿瘤患者是一种创伤小、疗效确切的手术方法，能够缓解疼痛，改善患者生活质量，减少局部病灶复发。
　　[关键词] 经皮椎体成形术；等离子消融；胸腰椎转移瘤；癌痛
　　[中图分类号] R687.3 [文献标识码] A [文章编号] 1673-7210（2018）02（c）-0071-04
　　Clinical study of percutaneous vertebroplasty combined with hypothermia plasma ablation in the treatment of thoracolumbar metastasis
　　LENG Yankui HOU Liqiang CAO Zhiqiang WANG Qiang WANG Haomin
　　Department of Orthopedics， Zhejiang Jinhua Guangfu Hospital， Zhejiang Province， Jinhua 321000， China
　　[Abstract] Objective To explore the clinical effect of percutaneous vertebroplasty combined with hypothermia plasma ablation in the treatment of thoracolumbar metastasis. Methods A total of 20 patients with malignant tumor thoracolumbar metastasis diagnosed by clinical imaging and pathology in Department of Orthopedics， Zhejiang Jinhua Guangfu Hospital from January 2010 to June 2015 were selected， and they were treated with percutaneous minimally invasive vertebroplasty combined with hypothermia plasma ablation under local anesthesia. The visual analogue scale （VAS） before and after operation was compared， and the results of CT and X-ray were observed. Results All 20 cases gained successfull operation， they could move around by wearing a waist belt after operation for 2 h. They were followed-up for 12-30 months， with an average of 18 months. Postoperative thoracic waist pain was significantly reduced. The VAS score was reduced from （6.9±0.9） points before operation to （1.6±0.8） points after operation （P < 0.05）. The quality of life was improved significantly. The reexamination of CT and X-ray showed that the bone cement was filled satisfactorily， with no leakage. Conclusion Percutaneous vertebroplasty combined with hypothermia plasma ablation is a micro-invasive， effective palliative operation method for the malignant tumor patients with osteolytic metastatic lesion confined to the vertebral body， which can relieve pain， improve the quality of life， and reduce the recurrence of local lesions.
　　[Key words] Percutaneous vertebroplasty； Plasma ablation； Thoracolumbar metastasis； Cancer pain
　　恶性肿瘤有80%发生骨转移，其中脊柱转移瘤最多见。据统计，脊椎转移率仅次于肺和肝转移率，居第3位[1]。脊椎转移瘤以胸椎多见，其次为腰椎、颈椎、骶椎。椎体转移瘤是严重影响生活质量的恶性肿瘤并发症之一。其危害主要由于肿瘤对骨质的溶骨性破坏，使脊柱承重能力、稳定性降低，易发生椎体压缩性骨折；肿瘤病变侵犯脊髓可导致截瘫，剧烈疼痛，功能障碍等。改善患者的生活质量，增强病椎的稳定性和止痛是治疗脊椎溶骨性转移瘤的首要目的。目前大多数研究针对溶骨性病灶行椎体成形术镇痛及稳定脊柱效果明显，但存在病灶复发问题。有学者认为，病变椎体经骨水泥注射后，椎体高度得到一定的恢复，避免发生潜在的微骨折，防止椎体进一步塌陷，同时，骨水泥在椎体内的固化过程中产热，使引起疼痛的敏感神经末梢及肿瘤组织变性坏死[2]。但骨水泥固化产生的热量所形成的温度仍然处于一个较低的水平（≥45℃，<30 min），不足以彻底破坏及消除椎体内的肿瘤细胞，存在着复发的可能性。浙江金华广福医院骨科于2010年1月～2015年6月在局麻下经皮微创椎体成形联合低温等离子消融治疗胸腰椎转移瘤20例，在椎体成形术前，先对病灶行等离子消融，减少了病灶复发，中期临床效果满意，现报道如下：

相关热词搜索：腰椎 消融 等离子 低温 临床研究