摘要
目的:评估丙烯酸树脂骨水泥经皮球囊后凸椎体成形治疗脊柱转移瘤重建脊柱稳定性的特点。方法:选择2006-10/2008-01暨南大学医学院附属第二医院深圳市人民医院脊柱外科33例椎体转移瘤患者行球囊后凸椎体成形术治疗。所有病椎伴有不同程度骨质破坏并压缩骨折,经皮球囊后凸椎体成形在C臂X射线机的监视下完成,行双侧椎弓根穿刺,分别置入球囊,扩张椎体后注射丙烯酸树脂骨水泥,胸椎注射骨水泥平均量3.6mL、腰椎4.8mL。随访6个月,评估材料与宿主生物相容性、病椎高度的变化及手术前后疼痛程度及活动能力。结果:33例49个椎体中有43个椎体经皮球囊后凸椎体成形均一次成功。5例因肿瘤全身转移死亡。43个锥体进入结果分析。①病椎高度比较:手术前后椎体前缘[(2.2±0.6)cm,(2.6±0.6)cm]和后缘高度[(2.6±0.6)cm,(2.9±0.7)cm],经配对t检验,差异均有显著性意义(P<0.05),术后椎体高度较术前增高。②术前目测类比评分为(8.1±0.5)分,术后24h、1周和6个月分别为(2.1±1.4)分、(1.3±1.6)分和(0.9±1.5)分,4个时间点比较差异有显著性意义(P﹤0.01);术前活动能力评分为(3.4±0.5)分,术后24h、1周和6个月分别为(1.6±0.8)分、(1.3±0.6)分和(1.3±0.6)分,4个时间点比较差异有显著性意义(P<0.01)。经重复测量设计的方差分析,时间效应有统计学意义,呈线性趋势。③术前3例有神经根受损症状者术后缓解不明显;术中1例发生骨水泥椎管内渗漏及时改为开放手术,未发生神经受损症状;2例发生椎旁静脉内渗漏,未出现临床症状。除死亡者其余椎体未进一步压缩。结论:丙烯酸树脂骨水泥能有效增高压缩椎体高度,改善后凸畸形,增强病椎强度和稳定性,与宿主生物相容性好,经皮球囊后凸椎体成形微创手术能迅速缓解椎体转移瘤引起的疼痛。
AIM： To evaluate acrylic resin bone cement in combination with percutaneous kyphoplasty to treat spinal metastatic tumor and reconstruct spinal stability. METHODS： Thirty-three cases with spinal metastatic tumor underwent percutaneous kyphoplasty in the Department of Spinal Surgery, Shenzhen People＇s Hospital between October 2006 and January 2008. All affected spines were complicated by destruction of bone or compression fracture. Under monitoring by G-arm X-ray machine, bilateral pedicle puncture was performed, followed by balloon expanding and acrylic resin bone cement injection in thoracic vertebra （3.6 mL） and lumbar vertebra （4.8 mL）. All patients were followed up for 6 months to evaluate biocompatibility, vertebral height changes, pain degree pre- and post-surgery and movement ability. RESULTS： Of 49 affected vertebras in 33 cases, 43 were one-off successful, and 5 cases died of tumor metabasis. Finally, 43 vertebras were included in final analysis. The paired t-test showed the post-surgery anterior and posterior vertebral heights were significantly higher than pre-surgery [（2.6±0.6） cm, （2.2±0.6） cm; （2.9±0.7） cm, （2.6±0.6） cm; P 〈 0.05]. Pre-surgery visual analog scale scored （8.1±0.5）, and （2.1±1.4）, （1.3±1.6）, and （0.9±1.5） at 24 hours, 1 week and 6 months, and there were significant differences among four time points （P 〈 0.01）. Pre-surgery motion ability was scored （3.4±0.5）, and post-surgery motion ability was scored （1.6±0.8）, （1.3±0.6）, and （1.3±0.6） at 24 hours, 1 week and 6 months, respectively, and there were significant differences among four time points （P 〈 0.01）. The analysis of variance and time-effect showed linear tendency. Three cases of nerve root injury were not significantly improved after treatment; bone cement intraspinal canal leakage occurred in one case during the surgery, and open surgery was performed. In addition, two cases developed intravenous leakage, with no clinical symptoms. Compression in all vertebras did not change greatly except for the death. CONCLUSION： Acrylic resin bone cement effectively increases compressive vertebral height, improves kyphosis, enhances vertebral strength and stability, and exhibits good biocompatibility to the host. Percutaneous kyphoplasty rapidly relieves metastatic tumor-caused pain.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2008年第36期7089-7092,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
