經(jīng)皮椎體成形術(shù)聯(lián)合低溫等離子消融治療胸腰椎轉(zhuǎn)移瘤的臨床研究

　　[摘要] 目的 探討椎體成形聯(lián)合低溫等離子消融技術(shù)治療胸腰椎轉(zhuǎn)移瘤的臨床效果。 方法 選取2010年1月～2015年6月于浙江金華廣福醫(yī)院骨科就診且臨床影像和病理確診為惡性腫瘤胸腰椎轉(zhuǎn)移瘤患者20例，行局麻下經(jīng)皮微創(chuàng)椎體成形術(shù)聯(lián)合低溫等離子消融治療。比較患者術(shù)前、術(shù)后視覺模擬評分（VAS），觀察CT及X線片結(jié)果。 結(jié)果 20例手術(shù)均獲得成功，術(shù)后2 h佩戴腰圍帶下地活動，隨訪12～30個月，平均18個月，術(shù)后患者胸腰部疼痛明顯減輕，VAS評分由術(shù)前（6.9±0.9）分降至術(shù)后（1.6±0.8）分（P < 0.05），生活質(zhì)量得到顯著提高，復(fù)查CT及X線片提示病灶骨水泥填充滿意，無滲漏。 結(jié)論 經(jīng)皮椎體成形術(shù)聯(lián)合低溫等離子消融術(shù)對于局限于椎體的溶骨性轉(zhuǎn)移病灶惡性腫瘤患者是一種創(chuàng)傷小、療效確切的手術(shù)方法，能夠緩解疼痛，改善患者生活質(zhì)量，減少局部病灶復(fù)發(fā)。
　　[關(guān)鍵詞] 經(jīng)皮椎體成形術(shù)；等離子消融；胸腰椎轉(zhuǎn)移瘤；癌痛
　　[中圖分類號] R687.3 [文獻(xiàn)標(biāo)識碼] A [文章編號] 1673-7210（2018）02（c）-0071-04
　　Clinical study of percutaneous vertebroplasty combined with hypothermia plasma ablation in the treatment of thoracolumbar metastasis
　　LENG Yankui HOU Liqiang CAO Zhiqiang WANG Qiang WANG Haomin
　　Department of Orthopedics， Zhejiang Jinhua Guangfu Hospital， Zhejiang Province， Jinhua 321000， China
　　[Abstract] Objective To explore the clinical effect of percutaneous vertebroplasty combined with hypothermia plasma ablation in the treatment of thoracolumbar metastasis. Methods A total of 20 patients with malignant tumor thoracolumbar metastasis diagnosed by clinical imaging and pathology in Department of Orthopedics， Zhejiang Jinhua Guangfu Hospital from January 2010 to June 2015 were selected， and they were treated with percutaneous minimally invasive vertebroplasty combined with hypothermia plasma ablation under local anesthesia. The visual analogue scale （VAS） before and after operation was compared， and the results of CT and X-ray were observed. Results All 20 cases gained successfull operation， they could move around by wearing a waist belt after operation for 2 h. They were followed-up for 12-30 months， with an average of 18 months. Postoperative thoracic waist pain was significantly reduced. The VAS score was reduced from （6.9±0.9） points before operation to （1.6±0.8） points after operation （P < 0.05）. The quality of life was improved significantly. The reexamination of CT and X-ray showed that the bone cement was filled satisfactorily， with no leakage. Conclusion Percutaneous vertebroplasty combined with hypothermia plasma ablation is a micro-invasive， effective palliative operation method for the malignant tumor patients with osteolytic metastatic lesion confined to the vertebral body， which can relieve pain， improve the quality of life， and reduce the recurrence of local lesions.
　　[Key words] Percutaneous vertebroplasty； Plasma ablation； Thoracolumbar metastasis； Cancer pain
　　惡性腫瘤有80%發(fā)生骨轉(zhuǎn)移，其中脊柱轉(zhuǎn)移瘤最多見。據(jù)統(tǒng)計，脊椎轉(zhuǎn)移率僅次于肺和肝轉(zhuǎn)移率，居第3位[1]。脊椎轉(zhuǎn)移瘤以胸椎多見，其次為腰椎、頸椎、骶椎。椎體轉(zhuǎn)移瘤是嚴(yán)重影響生活質(zhì)量的惡性腫瘤并發(fā)癥之一。其危害主要由于腫瘤對骨質(zhì)的溶骨性破壞，使脊柱承重能力、穩(wěn)定性降低，易發(fā)生椎體壓縮性骨折；腫瘤病變侵犯脊髓可導(dǎo)致截癱，劇烈疼痛，功能障礙等。改善患者的生活質(zhì)量，增強(qiáng)病椎的穩(wěn)定性和止痛是治療脊椎溶骨性轉(zhuǎn)移瘤的首要目的。目前大多數(shù)研究針對溶骨性病灶行椎體成形術(shù)鎮(zhèn)痛及穩(wěn)定脊柱效果明顯，但存在病灶復(fù)發(fā)問題。有學(xué)者認(rèn)為，病變椎體經(jīng)骨水泥注射后，椎體高度得到一定的恢復(fù)，避免發(fā)生潛在的微骨折，防止椎體進(jìn)一步塌陷，同時，骨水泥在椎體內(nèi)的固化過程中產(chǎn)熱，使引起疼痛的敏感神經(jīng)末梢及腫瘤組織變性壞死[2]。但骨水泥固化產(chǎn)生的熱量所形成的溫度仍然處于一個較低的水平（≥45℃，<30 min），不足以徹底破壞及消除椎體內(nèi)的腫瘤細(xì)胞，存在著復(fù)發(fā)的可能性。浙江金華廣福醫(yī)院骨科于2010年1月～2015年6月在局麻下經(jīng)皮微創(chuàng)椎體成形聯(lián)合低溫等離子消融治療胸腰椎轉(zhuǎn)移瘤20例，在椎體成形術(shù)前，先對病灶行等離子消融，減少了病灶復(fù)發(fā)，中期臨床效果滿意，現(xiàn)報道如下：

相關(guān)熱詞搜索：腰椎 消融 等離子 低溫 臨床研究