CAJ | 학술논문

目的：评估125I放射性粒子植入联合椎体后凸成形术(percutaneouskyphoplasty，PKP)在治疗胸腰椎转移瘤中的应用价值。方法选取2009年1月至2013年12月，拟行经皮椎体成形术的胸腰椎转移瘤患者，对其是否联合125I放射性粒子植入术分为研究组与对照组。观察并记录术前及术后2周、1、3、6、12个月的VAS评分(visualanaloguescale)及KPS评分(karnofskyperformancescore)，比较两组各项指标的变化情况。结果研究组21例，对照组25例，手术均顺利完成，无围手术期死亡病例。所有病例均随访12～60个月，平均(37.5±15.9)个月，未发现骨水泥渗漏，研究组病例未发现放射性粒子移位或放射性脊髓损伤。研究组及对照组术前VAS评分分别为8.44±1.32、8.7±1.83，两组术后2周、1、3、6、12个月VAS分别为2.79±3.46、3.21±2.53、2.96±2.16、3.08±2.03、3.17±1.24及4.23±2.78、3.42±2.21、3.63±1.76、3.58±2.53、3.62±3.12，手术前后比较有统计学意义(P＜0.05)，且研究组较对照组改善更明显(P＜0.05)，说明联合125I放射性粒子植入止痛效果更明显。研究组和对照组术前KPS分别为55.0±11.7及60.9±16.4，术后2周，1、3、6、12个月分别为85.7±12.5、89.7±10.6、81.96±14.4、82.1±11.3、81.3±11.2及91.2±12.7、90.4±13.1、88.6±13.3、86.8±12.3、83.6±13.2，术后KPS分别较术前明显改善，但在术后2周、1、3、6、12个月各时间点的KPS评分两组间差异无统计学意(P＞0.05)，说明手术对于患者体力恢复的作用无明显差别。结论125I放射性粒子植入术联合PKP治疗脊柱转移瘤，在临床操作上安全可行，能达到缓解癌性疼痛、局部肿瘤控制、重建脊柱稳定性的作用，短期疗效可靠，为脊柱转移瘤患者提供了一种新的有效治疗方法。在疼痛控制方面，联合125I放射性粒子植入术较单纯椎体成形术效果更佳。
목적：평고125I방사성입자식입연합추체후철성형술(percutaneouskyphoplasty，PKP)재치료흉요추전이류중적응용개치。방법선취2009년1월지2013년12월，의행경피추체성형술적흉요추전이류환자，대기시부연합125I방사성입자식입술분위연구조여대조조。관찰병기록술전급술후2주、1、3、6、12개월적VAS평분(visualanaloguescale)급KPS평분(karnofskyperformancescore)，비교량조각항지표적변화정황。결과연구조21례，대조조25례，수술균순리완성，무위수술기사망병례。소유병례균수방12～60개월，평균(37.5±15.9)개월，미발현골수니삼루，연구조병례미발현방사성입자이위혹방사성척수손상。연구조급대조조술전VAS평분분별위8.44±1.32、8.7±1.83，량조술후2주、1、3、6、12개월VAS분별위2.79±3.46、3.21±2.53、2.96±2.16、3.08±2.03、3.17±1.24급4.23±2.78、3.42±2.21、3.63±1.76、3.58±2.53、3.62±3.12，수술전후비교유통계학의의(P＜0.05)，차연구조교대조조개선경명현(P＜0.05)，설명연합125I방사성입자식입지통효과경명현。연구조화대조조술전KPS분별위55.0±11.7급60.9±16.4，술후2주，1、3、6、12개월분별위85.7±12.5、89.7±10.6、81.96±14.4、82.1±11.3、81.3±11.2급91.2±12.7、90.4±13.1、88.6±13.3、86.8±12.3、83.6±13.2，술후KPS분별교술전명현개선，단재술후2주、1、3、6、12개월각시간점적KPS평분량조간차이무통계학의(P＞0.05)，설명수술대우환자체력회복적작용무명현차별。결론125I방사성입자식입술연합PKP치료척주전이류，재림상조작상안전가행，능체도완해암성동통、국부종류공제、중건척주은정성적작용，단기료효가고，위척주전이류환자제공료일충신적유효치료방법。재동통공제방면，연합125I방사성입자식입술교단순추체성형술효과경가。
Objective To evaluate the clinical value of implantation of Iodine-125 ( 125I ) radioactive seeds combined with ercutaneous kyphoplasty ( PKP ) in the treatment of thoracolumbar metastases. Methods PKP was planned for the patients with thoracolumbar metastases admitted from January 2009 to December 2013. All the patients were allocated to the study group and the control group depending on whether 125I radioactive seeds were implanted. The Visual Analogue Scale ( VAS ) and Karnofsky Performance Score ( KPS ) were recorded preoperatively and at 2 weeks, 1 month, 3 months, 6 months and 12 months after the operation, and the changes were compared between the 2 groups. Results There were 21 cases in the study group and 25 cases in the control group. The operation was successfully performed in all the patients, without perioperative deaths. The average follow-up period was ( 37.5±15.9 ) months ( range:12-60 months ). There was no leakage of bone cement. No seeds migration or radioactive myelitis was observed in the study group. The preoperative VAS score was 8.44±1.32 points in the study group, which were 2.79±3.46, 3.21±2.53, 2.96±2.16, 3.08±2.03 and 3.17±1.24 points respectively at 2 weeks, 1 month, 3 months, 6 months and 1 year after the operation. The VAS scores in the control group were 8.7±1.83, 4.23±2.78, 3.42±2.21, 3.63±1.76, 3.58±2.53 and 3.62±3.12 points respectively at the same time points. The preoperative and postoperative VAS scores were signiifcantly different in both groups ( P<0.05 ), and the improvement was more obviously shown in the study group ( P<0.05 ). It was illustrated that implantation of 125I radioactive seeds promoted the relief of pain. The preoperative KPS score in the study group was 55.0±11.7 points, which was 85.7±12.5, 89.7±10.6, 81.96±14.4, 82.1±11.3 and 81.3±11.2 points respectively at 2 weeks, 1 month, 3 months, 6 months and 1 year after the operation. In the control group, the KPS scores were 60.9±16.4, 91.2±12.7, 90.4±13.1, 88.6±13.3, 86.8±12.3 and 83.6±13.2 points at the same time points. The postoperative KPS score was obviously improved when compared the preoperative score in both groups. However, no statistically signiifcant differences existed between the 2 groups in the KPS scores at 2 weeks, 1 month, 3 months, 6 months and 1 year after the operation ( P>0.05 ). It was shown that no signiifcant differences existed in terms of physical recovery of the patients whether the operation was performed or not. Conclusions Implantation of 125I radioactive seeds PKP is a feasible and safe technique in the treatment of spinal metastases, which can relieve cancerous pain, control local tumor and reconstruct spinal stability. Its short-term curative effects are reliable, and a new treatment method is provided for the patients with spinal metastases. The combined implantation of 125I radioactive seeds is more effective in pain control than simple PKP.