经皮椎体后凸成形分次和温度梯度灌注骨水泥治疗胸腰椎转移性肿瘤张凡，杨惠林，管华清苏州大学附属第一医院骨科，江苏省苏州市215006PercutaneousvertebroplastyandbonecementperfusionatdifferenttimesandtemperaturegradientsformetastatictumorinthoraciclumbarvertebraeZhangFan,YangHui-lin,GuanHua-qingDepartmentofOrthopedics,FirstAffiliatedHospital,SoochowUniversity,Suzhou215006,JiangsuProvince,China摘要背景：经皮椎体后凸成形治疗已被广泛用于椎体骨质疏松性压缩性骨折，现在亦被用于治疗椎体转移性肿瘤。目的：评估采用经皮椎体后凸成形分次和温度梯度灌注骨水泥治疗胸腰椎转移性肿瘤效果。方法：回顾性分析经皮椎体后凸成形分次和温度梯度灌注骨水泥治疗胸腰椎转移性肿瘤病例共24例38椎，分为椎体压缩≥1/4组9例11椎和椎体压缩<1/4组15例27椎。在C臂机透视定位下行经皮椎体后凸成形，采用分次灌注、温度梯度灌注方法注射骨水泥。以目测类比评分及Owestry功能障碍指数评估经皮椎体后凸成形分次和温度梯度灌注骨水泥治疗前后疼痛缓解情况，日常功能恢复情况，治疗椎的高度变化。随访时间为12-56个月。结果与结论：24例患者均成功完成经皮椎体后凸成形分次和温度梯度灌注骨水泥治疗。平均单个胸椎内注射骨水泥(4±1)mL，单个腰椎内注射骨水泥(5±1)mL。治疗后复查X射线片见骨水泥分布良好，无神经根损伤或脊髓压迫症状。两组患者治疗后椎体高度显著高于治疗前(P<0.05)。所有患者治疗后1d、治疗后1个月及末次随访时目测类比评分、功能障碍指数值均显著低于治疗前(P<0.05)；两组相同时间点目测类比评分、功能障碍指数评分的改变值差异无显著性意义。结果表明经皮椎体后凸成形分次和温度梯度灌注骨水泥治疗胸腰椎转移性肿瘤，可减少骨水泥渗漏的发生，不论肿瘤转移椎体有无明显压缩，均能迅速缓解疼痛，是治疗椎体转移肿瘤的有效方法。中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程全文链接：关键词：植入物；脊柱植入物；经皮椎体后凸成形术；脊柱肿瘤；转移；压缩；无明显压缩；疗效比较；Abstract：BACKGROUND:Percutaneousvertebroplastyhasbeenextensivelyappliedintreatmentofosteoporoticvertebralcompressionfractures,andnowitisalsousedinspinalmetastatictumor.OBJECTIVE:Toevaluatetheeffectivenessofpercutaneousvertebroplastyformetastatictumorofthoraciclumbarvertebraebybonecementperfusionatdifferenttimesandtemperaturegradient.METHODS:Atotalof24cases(38vertebrae)ofmetastatictumorreceivingpercutaneousvertebroplastyandbonecementperfusionatdifferenttimesandtemperaturegradientwerereviewedretrospectively.AllpatientswereclassifiedintogroupA(11vertebraein9cases)featuredwithapparentvertebralcompression(≥1/4)andgroupB(27vertebraein15cases)ofnoobviouscompression(<1/4).ThepercutaneousvertebroplastywasconductedwithC-armfluoroscopypositioning.Bonecementwasinjectedbyperfusionatdifferenttimesandtemperaturegradientmethod.VisualAnalogueScalesandOwestryDisabilityIndexwererecordedtoassesspainalleviationandfunctionalrestorationbeforeandafterbonecementinjectionatdifferenttimesandtemperaturegradient.Theheightoftreatedvertebraewasalsoanalyzed.Follow-upwasperformedfor12to56months.RESULTSANDCONCLUSION:All24patientssuccessfullyunderwentpercutaneousvertebroplastyandbonecementperfusionatdifferenttimesandtemperaturegradient.Bonecement(4±1)mLwasaveragelyinjectedintoeachthoracicvertebra.Bonecement(5±1)mLwasinjectedintoeachlumbarvertebra.Postoperativerecheckradiographsrevealedgoodbonecementdistribution,nonerverootinjuryorspinalcompressionoccurred.Vertebralheightwassignificantlyhigherposttreatmentcomparedwithpretreatmentinbothgroups(P<0.05).VisualAnalogueScalesandOwestryDisabilityIndexscoresweres...