CAJ | 학술논문

目的评价125I放射性粒子植入术联合椎体成形术治疗椎体转移性肿瘤的临床疗效.方法 15例骨转移瘤患者共21个病灶,根据CT图像应用计算机治疗计划系统(TPS)制定粒子植入计划,按计划在CT引导下进行125I放射性粒子植入治疗.术后将X线片和CT扫描图像输入治疗计划系统进行质量验证.观察术后疼痛缓解情况和局部病灶的影像学变化.2个月后,行椎体成形术,骨水泥按甲基丙烯酸树脂多聚体/液态甲基丙烯酸树脂单体/造影剂3∶2∶1比例配制.胸腰骶椎区均采用经椎弓根或椎体后外侧穿刺,在确定穿刺到位并无椎管内渗漏后,将骨水泥快速灌注至椎体内.结果 125I放射性粒子植入术联合椎体成形术治疗骨转移瘤,其中8例为显效,6例为有效,1例为无效.治疗后疼痛分级明显降低.术后2个月CT复查显示,21个转移病灶中,局部控制7个,无变化12个,进展2个,病变控制率为90.5％(19/21).所有患者均未出现严重并发症.结论 125I放射性粒子植入术治疗椎体转移性肿瘤止痛效果好,不良反应发生率低且程度轻,是一种疗效较好的治疗方法.椎体成形术能够强化靶区硬度,且止痛效果迅速.125I放射性粒子植入术联合椎体成形术可以优势互补.
목적 평개125I방사성입자식입술연합추체성형술치료추체전이성종류적림상료효.방법 15례골전이류환자공21개병조,근거CT도상응용계산궤치료계화계통(TPS)제정입자식입계화,안계화재CT인도하진행125I방사성입자식입치료.술후장X선편화CT소묘도상수입치료계화계통진행질량험증.관찰술후동통완해정황화국부병조적영상학변화.2개월후,행추체성형술,골수니안갑기병희산수지다취체/액태갑기병희산수지단체/조영제3∶2∶1비례배제.흉요저추구균채용경추궁근혹추체후외측천자,재학정천자도위병무추관내삼루후,장골수니쾌속관주지추체내.결과 125I방사성입자식입술연합추체성형술치료골전이류,기중8례위현효,6례위유효,1례위무효.치료후동통분급명현강저.술후2개월CT복사현시,21개전이병조중,국부공제7개,무변화12개,진전2개,병변공제솔위90.5％(19/21).소유환자균미출현엄중병발증.결론 125I방사성입자식입술치료추체전이성종류지통효과호,불량반응발생솔저차정도경,시일충료효교호적치료방법.추체성형술능구강화파구경도,차지통효과신속.125I방사성입자식입술연합추체성형술가이우세호보.
Objective To study and evaluate the therapeutic efficacy of CT-guided radioactive 125Iseeds implantation combined with percutaneous vertebroplasty for spinal vertebra metastases.Methods Fifteen patients and 21 lesions were enrolled in this study.Based on the CT images,a computer-based treatment planning system (TPS) was used to determine the optimal seeds distribution.Under CT-guided,radioactive 125I seeds were implanted into the lesions.Based on the X-ray and CT image after the implantation,quality check was carried out with TPS.The ostalgia-relieving degree and the image alterations of the spinal vertebra metastases lesions were observed.Two months later,15 patients underwent percutaneous vertebroplasty with DSA guidance,bone cement was made according to the ratio methyl acrylic resin polymer/liquid methyl acrylic resin monomer/contrast as 3 ∶ 2 ∶ 1 in injecting paste form.The puncturation through pedicle of vertebral arch and lateral posterior body of vertebra was both adopted in thoracic and lumbosacral vertebrae site.After making sure that the puncturation was completed and there was no leakage in vertebral body,the bone cement was injected into vertebral body quickly.Results Accepted radioactive 125I seeds plantation,relief of pain was obtained.Among 15 patients,8 patients were powerful,6 patients were effective and 1 patient was inefficiency.After treatment,the pain grading significantly decreased.After treatment for 2 months,CT was used to recheck,7 lesions were local controlled,12 lesions had no changes,2 lesions were progress.The responsive rate was 90.5％ (19/21).No serious side-effect happened.Conclusions Radioactive 125I seeds implantation can be a safe and effective method in treating spinal vertebra metastases and obtaining good clinical effects with minimal damage and few complications.Percutaneous vertebroplasty can strengthen the target and relief pain quickly.CT-guided radioactive 125I seeds implantation combined with percutaneous vertebroplasty for the treatment of spinal vertebra metastases has complementary advantages.