CAJ | 학술논문

目的：观察大分割放射治疗联合经皮注射骨水泥椎体成形术（PVP）在脊椎骨转移瘤中的治疗效果。方法：骨转移疼痛患者52例，有明显疼痛椎体68个。以大分割放射治疗，分割剂量3Gy/次，或4Gy/次，1次/d，5次/周。总剂量：DT 30Gy/10次，或20Gy/5次；3天后应用 PVP 治疗脊柱转移性肿瘤52例共68个椎体，在 CT 引导下或 X 线电视监视下经皮穿刺至病变椎体后注入适量骨水泥（聚甲基丙烯酸甲酯，PMMA），观察放疗及 PVP 术后止痛效果、并发症及脊椎稳定性情况。结果：52例患者中，48例 DT 30Gy/10次，4例20Gy/5次，52例穿刺全部成功。放疗及 PVP 术后，患者的疼痛均有不同程度缓解：疼痛完全缓解（CR）42例（54个椎体）、疼痛部分缓解（PR）9例（12个椎体）、轻度缓解（MR）1例（2个椎体）、疼痛无缓解（NR）0例。病变脊椎稳定性良好，术后影学检查显示38例49个病椎的肿瘤区域被 PMMA 完全均匀充填加固，另14例19个椎体大部分充填。放疗中、PVP 术中及术后均无严重并发，随访3~6个月效果良好。结论：大分割放射治疗联合经皮注射骨水泥椎体成形术（PVP）治疗脊椎骨转移瘤缓解疼痛疗效好，并可加强病变椎体的稳定性。
목적：관찰대분할방사치료연합경피주사골수니추체성형술（PVP）재척추골전이류중적치료효과。방법：골전이동통환자52례，유명현동통추체68개。이대분할방사치료，분할제량3Gy/차，혹4Gy/차，1차/d，5차/주。총제량：DT 30Gy/10차，혹20Gy/5차；3천후응용 PVP 치료척주전이성종류52례공68개추체，재 CT 인도하혹 X 선전시감시하경피천자지병변추체후주입괄량골수니（취갑기병희산갑지，PMMA），관찰방료급 PVP 술후지통효과、병발증급척추은정성정황。결과：52례환자중，48례 DT 30Gy/10차，4례20Gy/5차，52례천자전부성공。방료급 PVP 술후，환자적동통균유불동정도완해：동통완전완해（CR）42례（54개추체）、동통부분완해（PR）9례（12개추체）、경도완해（MR）1례（2개추체）、동통무완해（NR）0례。병변척추은정성량호，술후영학검사현시38례49개병추적종류구역피 PMMA 완전균균충전가고，령14례19개추체대부분충전。방료중、PVP 술중급술후균무엄중병발，수방3~6개월효과량호。결론：대분할방사치료연합경피주사골수니추체성형술（PVP）치료척추골전이류완해동통료효호，병가가강병변추체적은정성。
Objective:To investigate the efficacy of hypofractionated radiotherapy combined with percutaneous ver-tebraplasty for the treatment of spinal vertebra metastases. Methods:Fifty - two patients with 68 sites of painful verte-bral body metastases were treated by hypofractionated radiotherapy with 3Gy or 4Gy each time and once a day,five times a week. The total dosage was 30Gy/ 10 for 20Gy/ 5f. Three days later,52 cases with 68 vertebral body metastases underwent PVP under the guidance of CT or luoroscopy. The analgesic effect,complications after radiotherapy and op-eration and vertebral body stability were observed. Results:In 52 cases,48 cases received 30Gy/ 10f,4 cases received 20Gy/ 5f. The successful rate of puncture was 100% . The pain relief was demonstrated in all cases(complete relief in 42 cases,partial relief in 9cases,mild relief in 1 case,no relief in 0 cases. All involved vertebral bodies had good sta-bility. Imaging analysis demonstrated that the metastatic area was completely well distributed filling and reinforce by polymethy methacrylate(PMMA)in 49 vertebra of 38 cases. The other 19 vertebral of 14 cases were great part filled by PMMA. There were no severe complications both during radiotherapy,operation and post operation. The treating effect was satisfying in the following 3 to 6 months. Conclusion:Hypofractionated radiotherapy combined with percuta-neous vertebraplasty for the treatment of spinal vertebra metastases is one of the efficacious way to alleviate pain of vertebral metastases,and it can reinforce the stability of involved vertebral body.