CAJ | 학술논문

背景：针对肿瘤破坏导致的椎体骨折，进而引起的神经功能障碍，单纯的放疗作用微小。近年来125I 放射粒子已广泛应用于多种原发或继发肿瘤并取得良好效果。经皮球囊扩张椎体后凸成形可效恢复椎体高度，重建脊柱稳定性，缓解疼痛症状。 　　目的：观察经皮球囊扩张椎体后凸成形骨水泥注入联合125I放射粒子治疗脊柱转移瘤的疗效及安全性。 　　方法：回顾性分析2011年3月至2012年7月经皮球囊扩张椎体后凸成形注入骨水泥联合125I放射粒子治疗的30例脊柱转移瘤患者，收集患者的症状、体征、影像学资料，治疗前均有顽固性背痛，CT提示有椎体骨质破坏。采用目测类比评分、WHO疼痛缓解标准、功能障碍指数来评估治疗后临床症状转归及神经功能恢复情况，测量病椎高度变化。随访时间为治疗后1d、1个月及6个月。 　　结果与结论：30例患者治疗过程顺利，治疗后24 h疼痛缓解，无神经损伤及压迫症状。治疗后目测类比评分、疼痛缓解情况、功能障碍指数、椎体高度均较治疗前显著改善(P<0.05)。治疗后随访1个月及6个月，目测类比评分、功能障碍指数、椎体高度变化与治疗后24 h差异无显著性意义(P>0.05)。骨水泥向椎间隙、前纵韧带下渗漏各2例无临床症状。提示经皮球囊扩张椎体后凸成形骨水泥注入联合125I放射粒子治疗脊柱转移瘤，能迅速缓解肿瘤所致的疼痛，有效恢复病椎高度，并发症少，显著提高患者生活质量。
배경：침대종류파배도치적추체골절，진이인기적신경공능장애，단순적방료작용미소。근년래125I 방사입자이엄범응용우다충원발혹계발종류병취득량호효과。경피구낭확장추체후철성형가효회복추체고도，중건척주은정성，완해동통증상。 　　목적：관찰경피구낭확장추체후철성형골수니주입연합125I방사입자치료척주전이류적료효급안전성。 　　방법：회고성분석2011년3월지2012년7월경피구낭확장추체후철성형주입골수니연합125I방사입자치료적30례척주전이류환자，수집환자적증상、체정、영상학자료，치료전균유완고성배통，CT제시유추체골질파배。채용목측류비평분、WHO동통완해표준、공능장애지수래평고치료후림상증상전귀급신경공능회복정황，측량병추고도변화。수방시간위치료후1d、1개월급6개월。 　　결과여결론：30례환자치료과정순리，치료후24 h동통완해，무신경손상급압박증상。치료후목측류비평분、동통완해정황、공능장애지수、추체고도균교치료전현저개선(P<0.05)。치료후수방1개월급6개월，목측류비평분、공능장애지수、추체고도변화여치료후24 h차이무현저성의의(P>0.05)。골수니향추간극、전종인대하삼루각2례무림상증상。제시경피구낭확장추체후철성형골수니주입연합125I방사입자치료척주전이류，능신속완해종류소치적동통，유효회복병추고도，병발증소，현저제고환자생활질량。
BACKGROUND:Radiotherapy alone is not suitable for tumor-caused vertebral fractures and neurological dysfunction. In recent years, 125I radiation particles have been widely used in a variety of primary or secondary tumors and achieved good results. Percutaneous kyphoplasty can restore vertebral height efficiently, remodel spinal stability, and relieve pain. OBJECTIVE:To evaluate safety and effectiveness of percutaneous kyphoplasty combined with 125I in patients with metastatic spinal tumors. METHODS:A retrospective study was conducted to review 30 cases of metastatic spinal tumors undergoing percutaneous kyphoplasty combined with 125I from March 2011 to July 2012. Symptoms, signs, and imaging findings were col ected and analyzed. Al the patients had a refractoriness back pain. CT scan showed osteolytic changes in the vertebrae. The visual analogue scales, WHO standards for pain relief and Owestry disability index were recorded to analyze the clinical symptoms outcome and recovery of neurological function, and the change of height in abnormal vertebrae was measured. The fol ow-up time was 1 day, 1 month and 6 months postoperatively. RESULTS AND CONCLUSION:Operations in al the 30 patients were done successful y. Al patients got a conspicuous pain relief in 24 hours after operation, and nospinal injury or compression was found. There were significant differences in scores of visual analogue scales, pain levels, Owestry disability index, and the height of vertebral bodies before and after operation (P<0.05). During postoperative fol ow-up of 1 and 6 months, scores of visual analogue scales, pain levels, Owestry disability index, and the height of vertebral bodies showed no difference from those at 24 hours postoperatively (P>0.05). Bone cement leakage occurred in the anterior longitudinal ligament (n=2) and intervertebral space (n=2), and no serious complications occurred. Percutaneous kyphoplasty combined with 125I is a safe and effective way to treat metastatic spinal tumors, which can quickly ease the pain caused by spinal tumor, recover the abnormal vertebral height, reduce complications and improve life quality of patients.