目的：探讨经皮椎体成型术（PVP）治疗脊柱转移癌的疗效和并发症的防治。方法：采用PVP治疗脊柱转移癌15例（病椎22节），包括颈椎5例、颈椎合并胸椎1例、胸椎3例、胸腰椎同时存在1例、腰椎4例、骶尾椎同时合并髂骨1例。所有患者术后1～2周进行病椎放疗。结果：15例中21节病椎施术成功，其中1例穿刺第二个病椎时误入蛛网膜下腔被迫放弃骨水泥注射。术后一周内病椎部位疼痛完全消失6例、疼痛明显减轻4例、疼痛无减轻或加重5例；术后三个月以上随访病椎部位疼痛完全消失12例，仍有轻微疼痛3例，但这3例仅需服用非甾体类止痛药物疼痛即可缓解。术后X线和CT复查发现18节病椎的肿瘤区域被骨水泥完全均匀充填加固，3节病椎的肿瘤区域大部充填。术后15节病椎发生骨水泥外漏，其中单纯椎旁漏3节、椎旁漏合并椎管内前静脉漏7节、椎旁漏合并椎管内硬膜前漏2节、椎旁合并皮下漏2节、椎间盘内漏1节。本组未出现严重后果。结论：PVP治疗脊柱转移癌能够凝滞病变、固化椎体、缓解疼痛，是一种安全有效的微创技术。结合放疗能够提高PVP的治疗效果。漯河市中心医院脊柱外科王海蛟

　　关键词  肿瘤；脊柱；椎体成型术   

　　Percutaneous vertebroplasty for spinal metastases/WANG Hai-jiao,LI Yu-wei,ZHAO Song-hai,et al//Chinese Journal of Spine and Spinal Cord,

　　Abstract Objective : To investigate the efficacy of Percutaneous vertebroplasty(PVP) for spinal metastases and the prevention and treatment of complications of PVP. Method: Fifteen patients (twenty-two pathological vertebrae) with spinal metastases underwent percutaneous vertebroplasty .Five cases were at the cervical level,1 at the cervical level with the thoracic level, 3 at the thoracic level, 3 at the thoracic with the lumbar level,4 at the lumbar level and 1 at the sacro-coccygeal level with the iliac. Radiation therapy was performed at pathological vertebral region in all cases at post-PVP. Result: The twenty-one pathological vertebrae in the 15 cases underwent PVP successfully. One of the 22 pathological vertebrae (the second pathological vertebrae of some patient) failed to undergo PVP due to a biopsy needle into subarachnoid.  Complete relief of pain was obtained in 6 cases within 1st week, marked relief in 4 cases, no relief of pain or increased pain in 5 cases.  Complete relief of pain was obtained in 12 cases at more than 3-months follow-up, mild pain in 3 cases which disappear after use of analgesic. Postoperative X-ray film and CT scan showed the complete lesion filling with cement in 18 pathological vertebrae, the lesion filling in a great measure in 3. The leakages of cement occurred among the fifteen levels, which consist of para-vertebral leakages in the 3 levels, the para-vertebral with the anterior venous leakages in the spinal canal in 7, the para-vertebral with epidural leakages in 2, the para-vertebral with the subcutaneous leakages in 2, the intervertebral leakage in 1. No severe complications occurred in the group. Conclusion: PVP can stagnate a lesion and solidify vertebrae as well as relive pain for spinal metastases with safe and effective and mini-trauma technique. Radiation therapy can increase efficacy of PVP.  

　　Author’s  address  Department of Spine Surgery, Luohe First People’s Hospital, Henan, 46200, China  

　　Key words   Tumor; Spinal column; Vertebroplasty

　　经皮椎体成型术（Percutaneous Vertebroplasty, PVP）是在影像学技术（X线、CT等）引导下应用骨穿针经过皮肤穿刺到病变椎体，然后将骨水泥注入，凝止加固病变的一种介入技术。1987年法国放射医师Galibert[1]首先报告了PVP治疗颈椎血管瘤获得成功，1989年被应用于椎体转移性肿瘤的治疗，获得了满意的疗效[2]。

　　1　材料与方法

　　1.1一般资料

　　图1 椎骨造影显示

　　造影剂进入蛛网膜下腔