Chen Lei, Lin Jianhua, Zhu Xia, Wu Chaoyang
Department of Orthopedics, First Affiliated Hospital of Fujian Medical University, Fuzhou Fujian 350004, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011 Nov;25(11):1298-301.
To investigate the diagnosis and effectiveness of improved percutaneous kyphoplasty (PKP) for patients with thoracolumbar metastatic tumors, who could not tolerate anesthesia and open operation.
Between September 2009 and September 2010, 16 patients with thoracolumbar metastatic tumors underwent improved PKP. Of 16 patients, 7 were male and 9 were female with an average age of 64.5 years (range, 60-73 years). All patients had vertebral metastasis tumor. The disease duration was 3-6 months with an average of 4 months. The visual analogue scale (VAS) score was 8.9 +/- 0.8. No spinal cord compression and nerve root compression was observed. The involved vertebrae included T7 in 1 case, T8 in 1, T12 in 1, L2 in 2, L3 in 2, L4 in 3, T1,2 in 1, T3,4 in 1, T7,8 in 1, T11, 12 in 1, T7-L1 in 1, and T12-L4 in 1. Nine patients had vertebral compression fracture with a vertebral compression rate below 75%.
All patients were successfully performed PKP. There was no serious adverse reactions in cardiopulmonary and brain vascular systems and no perioperative death. The biopsy results showed that all were metastatic adenocarcinoma. All patients were followed up 9-18 months (mean, 14 months). Complete pain relief was achieved in 14 cases and partial relief in 2 cases 6 months after operation according to World Health Organization criterion, with a pain-relief rate of 87.5%. The VAS score was 1.8 +/- 0.6 at 6 months postoperatively, showing significant difference when compared with the preoperative score (P < 0.05). Two patients had cement leakages in 3 vertebrae with no symptoms at 6 months postoperatively. During follow-up, 12 patients died and the others survived with tumor.
For patients with thoracolumbar metastatic tumors who can not tolerate anesthesia and open operation, improved PKP has the advantages such as minimal invasion, high diagnostic rate, and early improvement of pain in the biopsy and treatment. It can improve patient's quality of life in the combination of radiotherapy or chemotherapy.
探讨改良经皮椎体后凸成形术（PKP）对无法耐受麻醉及开放手术的胸腰椎转移性肿瘤患者的诊断价值及疗效。
2009年9月至2010年9月，16例胸腰椎转移性肿瘤患者接受改良PKP治疗。16例患者中，男性7例，女性9例，平均年龄64.5岁（范围60 - 73岁）。所有患者均有椎体转移瘤，病程3 - 6个月，平均4个月。视觉模拟评分（VAS）为8.9±0.8。未观察到脊髓及神经根受压。受累椎体包括：T7 1例、T8 1例、T12 1例、L2 2例、L3 2例、L4 3例、T1,2 1例、T3,4 1例、T7,8 1例、T11,12 1例、T7 - L1 1例、T12 - L4 1例。9例患者存在椎体压缩骨折，椎体压缩率低于75%。
所有患者PKP手术均成功。未出现心肺及脑血管系统严重不良反应，无围手术期死亡。活检结果显示均为转移性腺癌。所有患者随访9 - 18个月（平均14个月）。术后6个月，根据世界卫生组织标准，14例患者疼痛完全缓解，2例部分缓解，疼痛缓解率为87.5%。术后6个月VAS评分为1.8±0.6，与术前评分相比差异有统计学意义（P < 0.05）。2例患者3个椎体出现骨水泥渗漏，术后6个月无症状。随访期间，12例患者死亡，其余患者带瘤生存。
对于无法耐受麻醉及开放手术的胸腰椎转移性肿瘤患者，改良PKP具有创伤小、诊断率高、活检及治疗后疼痛早期改善等优点。联合放疗或化疗可提高患者生活质量。
