CAJ | 학술논문

背景：目前椎体成形和椎管减压内固定是治疗脊柱转移瘤的常用方法，125 I 放射性粒子植入控制肿瘤的临床疗效也已得到研究证实，但是关于上述3种方法的综合治疗的临床研究很少。目的：比较采用125 I 放射性粒子植入联合椎体成形椎弓根钛合金钉棒内固定与单纯椎体成形椎弓根钛合金钉棒内固定治疗胸腰椎转移瘤在疼痛控制、内固定后体力恢复状态及脊髓神经功能改善等方面的差异，评价125 I放射性粒子植入联合治疗方案的临床应用价值。方法：选择2009年10月至2013年3月于深圳市人民医院脊柱外科手术治疗的胸腰椎转移瘤患者，以脊柱后路胸腰椎钛合金钉棒置入内固定系统，并根据其是否联合125 I放射性粒子植入分为实验组与对照组。观察记录各组钛合金钉棒内固定前及内固定后2周，内固定后1，6，12个月的脊髓神经功能改善情况。结果与结论：所有患者均获得随访，随访时间7-29个月，平均15.8个月，脊柱后路胸腰椎钛合金钉棒内固定系统未发生松动断裂，骨水泥分布良好，实验组患者未发现放射性粒子移位及放射性脊髓损伤，随访期内未见病椎局部肿瘤明显复发扩散。实验组患者内固定后目测类比疼痛评分、行为状态评分较对照组明显改善(P<0.05)，而2组患者内固定后Frankel分级均分别较内固定前明显改善，2组间神经功能改善情况差异无显著性意义(P >0.05)。说明125I放射性粒子植入联合椎体成形椎弓根钛合金钉棒内固定治疗脊柱转移瘤缓解癌性疼痛的效果更为明显。
배경：목전추체성형화추관감압내고정시치료척주전이류적상용방법，125 I 방사성입자식입공제종류적림상료효야이득도연구증실，단시관우상술3충방법적종합치료적림상연구흔소。목적：비교채용125 I 방사성입자식입연합추체성형추궁근태합금정봉내고정여단순추체성형추궁근태합금정봉내고정치료흉요추전이류재동통공제、내고정후체력회복상태급척수신경공능개선등방면적차이，평개125 I방사성입자식입연합치료방안적림상응용개치。방법：선택2009년10월지2013년3월우심수시인민의원척주외과수술치료적흉요추전이류환자，이척주후로흉요추태합금정봉치입내고정계통，병근거기시부연합125 I방사성입자식입분위실험조여대조조。관찰기록각조태합금정봉내고정전급내고정후2주，내고정후1，6，12개월적척수신경공능개선정황。결과여결론：소유환자균획득수방，수방시간7-29개월，평균15.8개월，척주후로흉요추태합금정봉내고정계통미발생송동단렬，골수니분포량호，실험조환자미발현방사성입자이위급방사성척수손상，수방기내미견병추국부종류명현복발확산。실험조환자내고정후목측류비동통평분、행위상태평분교대조조명현개선(P<0.05)，이2조환자내고정후Frankel분급균분별교내고정전명현개선，2조간신경공능개선정황차이무현저성의의(P >0.05)。설명125I방사성입자식입연합추체성형추궁근태합금정봉내고정치료척주전이류완해암성동통적효과경위명현。
BACKGROUND:At present, vertebroplasty and spinal canal decompression are common methods for treatment of metastatic spinal tumors. Iodine-125 (125 I) radioactive seed implantation has been shown to control the tumor. However, there were few clinical studies on combined therapy using above-mentioned methods. OBJECTIVE:To compare the differences of 125I radioactive seed implantation combined with vertebroplasty and titanium al oy nail-rod fixation and vertebroplasty combined with titanium al oy nail-rod fixation for treating thoracolumbar metastases on pain control, general performance and improvement of the spinal cord function, and to evaluate clinical value of 125 I radioactive seed implantation combined with therapeutic plans. METHODS:Thoracolumbar metastases patients undergoing titanium al oy nail-rod fixation were selected in the Department of Spinal Surgery, Shenzhen Municipal People’s Hospital in China from October 2009 to March 2013. They were assigned to experimental and control groups according to with or without 125 I radioactive seed implantation. Improvement in neurological function was observed before and 2 weeks, 1, 6, and 12 months after titanium al oy nail-rod fixation in both groups. RESULTS AND CONCLUSION:Al patients were fol owed up for 7 to 29 months, averagely 15.8 months. There was no loosening of titanium al oy nail-rod fixation and the position of bone cement was good. No seed migration or radioactive spinal cord injury was observed. No relapse or diffusion in the surgical site was observed during fol ow up. Visual Analogue Scale and Karnofsky Performance Status scores were higher in the experimental group than in the control group (P<0.05). Frankel level was obviously improved after fixation in both groups compared with preoperation. No significant difference in the improvement of neurological function was detected between the two groups (P>0.05). Results indicated that 125 I radioactive seed implantation combined with vertebroplasty and titanium al oy nail-rod fixation for treatment of metastatic spinal tumors showed obvious outcomes in relieving cancer pain.