中国脊柱脊髓杂志
中國脊柱脊髓雜誌
중국척주척수잡지
CHINESE JOURNAL OF SPINE AND SPINAL CORD
2009年
11期
823-826
,共4页
王少飞%王宇飞%杨克敏%张国志%侯开宇
王少飛%王宇飛%楊剋敏%張國誌%侯開宇
왕소비%왕우비%양극민%장국지%후개우
脊柱转移肿瘤%近距离照射%125I粒子%后路内固定
脊柱轉移腫瘤%近距離照射%125I粒子%後路內固定
척주전이종류%근거리조사%125I입자%후로내고정
Spinal metastatic tumor%Brachytherapy%Iodine-125 seeds%Posterior spinal fixation
目的:探讨经后路内同定结合放射性粒子~(125)I置入近距离照射治疗脊柱转移瘤的近期效果.方法:2004年7月~2008年3月收治17例脊柱转移肿瘤致脊柱不稳伴顽固性腰背部疼痛或神经根性疼痛不宜行肿瘤切除的患者,先经后路脊柱内固定系统重建脊柱稳定性.再在C型臂X线机监视下置入~(125)I粒子近距离照射.随访观察治疗效果.结果:随访7~39个月,平均21.3个月.术后3~26d起效,12例疼痛缓解(VAS评分<20mm),3例减轻(VAS评分20-40ram),2例无改善.11例有神经功能损害的患者8例明显改善,2例无改善,1例加重.2例分别于术后7个月、8个月死于肝脏衰竭,1例于术后15个月死于多器官衰竭,其余14例患者末次随访时仍存活.5例复查肿瘤生长得到抑制,无再发椎体转移.结论:对于转移瘤致脊柱不稳定,有顽同性疼痛又不宜行肿瘤切除者,经后路椎弓根钉系统重建脊柱稳定性同时置入放射性粒子近距离照射治疗可以缓解疼痛、延缓肿瘤生长,同时避免脊柱的稳定性丧失.
目的:探討經後路內同定結閤放射性粒子~(125)I置入近距離照射治療脊柱轉移瘤的近期效果.方法:2004年7月~2008年3月收治17例脊柱轉移腫瘤緻脊柱不穩伴頑固性腰揹部疼痛或神經根性疼痛不宜行腫瘤切除的患者,先經後路脊柱內固定繫統重建脊柱穩定性.再在C型臂X線機鑑視下置入~(125)I粒子近距離照射.隨訪觀察治療效果.結果:隨訪7~39箇月,平均21.3箇月.術後3~26d起效,12例疼痛緩解(VAS評分<20mm),3例減輕(VAS評分20-40ram),2例無改善.11例有神經功能損害的患者8例明顯改善,2例無改善,1例加重.2例分彆于術後7箇月、8箇月死于肝髒衰竭,1例于術後15箇月死于多器官衰竭,其餘14例患者末次隨訪時仍存活.5例複查腫瘤生長得到抑製,無再髮椎體轉移.結論:對于轉移瘤緻脊柱不穩定,有頑同性疼痛又不宜行腫瘤切除者,經後路椎弓根釘繫統重建脊柱穩定性同時置入放射性粒子近距離照射治療可以緩解疼痛、延緩腫瘤生長,同時避免脊柱的穩定性喪失.
목적:탐토경후로내동정결합방사성입자~(125)I치입근거리조사치료척주전이류적근기효과.방법:2004년7월~2008년3월수치17례척주전이종류치척주불은반완고성요배부동통혹신경근성동통불의행종류절제적환자,선경후로척주내고정계통중건척주은정성.재재C형비X선궤감시하치입~(125)I입자근거리조사.수방관찰치료효과.결과:수방7~39개월,평균21.3개월.술후3~26d기효,12례동통완해(VAS평분<20mm),3례감경(VAS평분20-40ram),2례무개선.11례유신경공능손해적환자8례명현개선,2례무개선,1례가중.2례분별우술후7개월、8개월사우간장쇠갈,1례우술후15개월사우다기관쇠갈,기여14례환자말차수방시잉존활.5례복사종류생장득도억제,무재발추체전이.결론:대우전이류치척주불은정,유완동성동통우불의행종류절제자,경후로추궁근정계통중건척주은정성동시치입방사성입자근거리조사치료가이완해동통、연완종류생장,동시피면척주적은정성상실.
Objective:To evaluate the preliminary results of posterior internal-fixation combined with iodine-125 (~(125)I) interstitial brachytherapy in the treatment of spinal metastatic tumors.Method:From July 2004 to March 2008,17 cases with spinal metastatic tumors who had spinal instability and intractable back pain or nerve root pain and were not suitable for tumor resection underwent ~(125)I seeds implantation under the guidance of C-arm fluoroscopy after posterior internal-fixation to reconstruct the spinal stability.Result:The time of follow-up was 7-39 months averaged 21.3 months.The effect was revealed 3-26 days after the operation. 12 cases had complete pain relief(VAS scores <20mm),3 cases had partial pain relief(VAS scores were between 20-40mm).2 cases had no pain relief(VAS scores >40mm).8 of 11 cases who presented neurological dysfunction showed a good recovery,but 2 cases had no change at all and 1 case became wrose.2 cases died of hepatic failure at 7th and 8th months respectively after operation.One case died of multiple organs failure (MOF) 15 months later.The other 14 cases were alive at the final follow-up.The tumor growth was restrained and no recurrence of vertebral metastasis was found in 5 cases. Conclusion: Posterior internal-fixation for reconstruction of spinal stability combined with ~(125)I interstitial brachytherapy is a good alternative for the treatment of spinal metastatic tumors which lead to spinal instability and intractable pain,or are unresectable.lt can relieve pain,restrain the growth of tumor,and avoid losing spinal stability.