椎体成形术在椎体肿瘤治疗中的应用
|
摘要
目的探讨椎弓根途径椎体成形术及开放性手术联合椎体成形术治疗椎体转移瘤、血管瘤和多发性骨髓瘤的适应症选择、手术方法和临床治疗效果。
材料和方法本组12例,男7例,女5例,38-78岁,平均55.58岁,自2003年2月至2009年5月对12例胸、腰椎椎体肿瘤患者实行了椎弓根途径椎体成形术,其中行经皮穿刺椎体成形术5例,后路椎管减压内固定、椎体成形术7例。本组患者骨髓瘤8例,血管瘤1例,脊柱转移瘤3例,其中包括肺癌1例,肾癌1例,神经内分泌肿瘤1例。病变椎体分布胸椎10个椎体,腰椎椎体7个。1例患者术前曾有放疗史,1例患者曾有化疗史,所有患者均有胸腰背部疼痛。术前VAS评分平均为6.8±0.99分。其中2例有脊髓压迫和下肢症状,Frankel分级为B级1例,C级1例。本组患者行经皮穿刺椎体成形术者均经单侧椎弓根穿刺。
结果所有患者分别于术后1周、3个月、6个月、12个月进行疼痛、神经症状和生活质量评价。随访平均37个月。术后3天内疼痛明显缓解,活动能力增加,患者对手术效果满意,术后第3天平均VAS评分降至1.0±0.71分,差异具有显著的统计学意义(P<0.01)。2例截瘫患者Frankle分级分别从术前的B级、C级变为D级。椎体成形术骨水泥注入量平均为3ml。1例患者骨水泥渗漏至椎体侧前方(见图1)。术后骨髓瘤患者均接受化疗。神经功能：术后未出现因骨水泥渗漏导致的神经损伤。术后随访中未发现椎体塌陷加重及邻近节段椎体发生压缩性骨折。
结论椎弓根途径椎体成形术对胸腰椎椎体肿瘤有良好的止痛效果,能够稳定椎体,有效预防椎体病理性骨折的发生,明显提高患者生存质量,已得到临床循证医学的肯定,是治疗椎体溶骨性肿瘤的有效方法。椎体后壁不完整是经皮椎体成形术和后凸成形术的禁忌症,但是开放性手术可以在直视下监控骨水泥在椎管内的渗漏情况,因此开放行椎体成形术可被广泛应用。由于椎体转移性肿瘤和多发性骨髓瘤患者的全身情况一般较差,脊柱多节段受累,身体其他部位的骨骼亦有受累,需要在尽可能短的时间内解决疼痛和脊髓压迫症状,但是患者无法承受创伤较大的前路或前后路联合椎体切除,椎管减压内固定术,因此后路椎管减压内固定、椎体成形术可一次性解除脊髓压迫,稳定脊柱,减少了手术创伤和手术风险,缩短了手术时间,手术效果确切。本组病例的临床效果进一步说明了后路椎管减压内固定联合椎体成形术的有效性和安全性,可以更好地缓解疼痛,改善神经症状,提高患者的生活质量,为无法承受脊柱前路手术的患者提供了一种可选择的手术方式。
Objective To evaluate the indication and clinical efficacy of vertebroplasty and open vertebroplasty in the treatment of spinal metastases, hemangioma and multiple myeloma.
Materials and Methods From February 2003 to May 2009,12 patients underwent vertebroplasty. There were 7 men,5 women. Their mean age was 55.58(range,38-78).5 of 12 patients underwent percutaneous vertebroplasty.7 of them underwent posterior spinal cord decompression, internal fixation and vertebroplasty during the same operation. There were 8 patients with multiple myeloma,1 with hemangioma and 3 with metastases, including 1 with lung cancer,1 with renal carcinoma and 1 with neuroendocrine tumor.17 levels were treated.10 thoracic vertebarl bodies and 7 lumbar vertebral bodies were affected.1 patient underwent preoperative radiotherapy.1 patient underwent preoperative chemotherapy. All patients complained severe back or lumbar pain. The mean visual analog scale (VAS) was 6.8±0.99. Spinal compression and neurological deficits of lower limb preoperatively were seen in 2 patients. According to system of Frankel and neurological function,1 patient was grade B.1 was grade C. All percutaneous vertebroplasty were unipedicular.
Results
The alleviation of pain and capability of movement were reevaluated on 1 week,3 months,6 months and 12 months after operation. All patients were followed up. The mean follow-up period was 37 months. The pain was dramatically reduced 3 days after operation. The movement capability was improved. The patients were satisfied. The mean VAS decreased to 1.0±0.71. The difference is statistical (P＜0.01). Two patients recovered from grade B and C to grade D after operation. The mean injection volume of cement was 3 ml. Cement leakage was revealed in 1 patient (figure 1). All patients suffered from multiple myeloma received postoperative chemotherapy. No procedure-related complications occurred. We did not find deteriorated vertebral body get worse and compression fracture of consecutive vertebral body.
Conclusions
Vertebroplasty can reduce the pain from tumor of thoracic and lumbar vertebral body satisfyingly, consolidate the vertebral body, prevent pathological fracture of deteriorated vertebral body and improve living quality. It was demonstrated by evidence-based medicine. It has been an effective way to treat osteolytic tumor. Incompleteness of posterior wall of vertebral body was contraindication of PVP and PKP. Open vertebroplasty can monitor the cement leakage in the spinal canal and be used widely. The patients suffered from spinal metastases and multiple myeloma were in poor general health and not able to bear the anterior vertebrectomy or anterior and posterior combined vertebrectomy, decompression of spinal canal. The open vertebroplasty can alleviate the spinal cord symptoms and stabilizate vertebral volumn. It can reduce operative time, surgical trauma and risks. This group of cases conformed the safety and efficacy of PVP, PKP and open vertebroplasty. This procedure provide an alternative treatment for the patients with spinal metastases and multiple myeloma. Better results of pain relief and neurologic recovery and living quality can be achieved.
材料和方法本组12例,男7例,女5例,38-78岁,平均55.58岁,自2003年2月至2009年5月对12例胸、腰椎椎体肿瘤患者实行了椎弓根途径椎体成形术,其中行经皮穿刺椎体成形术5例,后路椎管减压内固定、椎体成形术7例。本组患者骨髓瘤8例,血管瘤1例,脊柱转移瘤3例,其中包括肺癌1例,肾癌1例,神经内分泌肿瘤1例。病变椎体分布胸椎10个椎体,腰椎椎体7个。1例患者术前曾有放疗史,1例患者曾有化疗史,所有患者均有胸腰背部疼痛。术前VAS评分平均为6.8±0.99分。其中2例有脊髓压迫和下肢症状,Frankel分级为B级1例,C级1例。本组患者行经皮穿刺椎体成形术者均经单侧椎弓根穿刺。
结果所有患者分别于术后1周、3个月、6个月、12个月进行疼痛、神经症状和生活质量评价。随访平均37个月。术后3天内疼痛明显缓解,活动能力增加,患者对手术效果满意,术后第3天平均VAS评分降至1.0±0.71分,差异具有显著的统计学意义(P<0.01)。2例截瘫患者Frankle分级分别从术前的B级、C级变为D级。椎体成形术骨水泥注入量平均为3ml。1例患者骨水泥渗漏至椎体侧前方(见图1)。术后骨髓瘤患者均接受化疗。神经功能：术后未出现因骨水泥渗漏导致的神经损伤。术后随访中未发现椎体塌陷加重及邻近节段椎体发生压缩性骨折。
结论椎弓根途径椎体成形术对胸腰椎椎体肿瘤有良好的止痛效果,能够稳定椎体,有效预防椎体病理性骨折的发生,明显提高患者生存质量,已得到临床循证医学的肯定,是治疗椎体溶骨性肿瘤的有效方法。椎体后壁不完整是经皮椎体成形术和后凸成形术的禁忌症,但是开放性手术可以在直视下监控骨水泥在椎管内的渗漏情况,因此开放行椎体成形术可被广泛应用。由于椎体转移性肿瘤和多发性骨髓瘤患者的全身情况一般较差,脊柱多节段受累,身体其他部位的骨骼亦有受累,需要在尽可能短的时间内解决疼痛和脊髓压迫症状,但是患者无法承受创伤较大的前路或前后路联合椎体切除,椎管减压内固定术,因此后路椎管减压内固定、椎体成形术可一次性解除脊髓压迫,稳定脊柱,减少了手术创伤和手术风险,缩短了手术时间,手术效果确切。本组病例的临床效果进一步说明了后路椎管减压内固定联合椎体成形术的有效性和安全性,可以更好地缓解疼痛,改善神经症状,提高患者的生活质量,为无法承受脊柱前路手术的患者提供了一种可选择的手术方式。
Objective To evaluate the indication and clinical efficacy of vertebroplasty and open vertebroplasty in the treatment of spinal metastases, hemangioma and multiple myeloma.
Materials and Methods From February 2003 to May 2009,12 patients underwent vertebroplasty. There were 7 men,5 women. Their mean age was 55.58(range,38-78).5 of 12 patients underwent percutaneous vertebroplasty.7 of them underwent posterior spinal cord decompression, internal fixation and vertebroplasty during the same operation. There were 8 patients with multiple myeloma,1 with hemangioma and 3 with metastases, including 1 with lung cancer,1 with renal carcinoma and 1 with neuroendocrine tumor.17 levels were treated.10 thoracic vertebarl bodies and 7 lumbar vertebral bodies were affected.1 patient underwent preoperative radiotherapy.1 patient underwent preoperative chemotherapy. All patients complained severe back or lumbar pain. The mean visual analog scale (VAS) was 6.8±0.99. Spinal compression and neurological deficits of lower limb preoperatively were seen in 2 patients. According to system of Frankel and neurological function,1 patient was grade B.1 was grade C. All percutaneous vertebroplasty were unipedicular.
Results
The alleviation of pain and capability of movement were reevaluated on 1 week,3 months,6 months and 12 months after operation. All patients were followed up. The mean follow-up period was 37 months. The pain was dramatically reduced 3 days after operation. The movement capability was improved. The patients were satisfied. The mean VAS decreased to 1.0±0.71. The difference is statistical (P＜0.01). Two patients recovered from grade B and C to grade D after operation. The mean injection volume of cement was 3 ml. Cement leakage was revealed in 1 patient (figure 1). All patients suffered from multiple myeloma received postoperative chemotherapy. No procedure-related complications occurred. We did not find deteriorated vertebral body get worse and compression fracture of consecutive vertebral body.
Conclusions
Vertebroplasty can reduce the pain from tumor of thoracic and lumbar vertebral body satisfyingly, consolidate the vertebral body, prevent pathological fracture of deteriorated vertebral body and improve living quality. It was demonstrated by evidence-based medicine. It has been an effective way to treat osteolytic tumor. Incompleteness of posterior wall of vertebral body was contraindication of PVP and PKP. Open vertebroplasty can monitor the cement leakage in the spinal canal and be used widely. The patients suffered from spinal metastases and multiple myeloma were in poor general health and not able to bear the anterior vertebrectomy or anterior and posterior combined vertebrectomy, decompression of spinal canal. The open vertebroplasty can alleviate the spinal cord symptoms and stabilizate vertebral volumn. It can reduce operative time, surgical trauma and risks. This group of cases conformed the safety and efficacy of PVP, PKP and open vertebroplasty. This procedure provide an alternative treatment for the patients with spinal metastases and multiple myeloma. Better results of pain relief and neurologic recovery and living quality can be achieved.
引文
1.Klimo P Jr, Schmidt MH. Surgical management of spinal metastases. Oncologist,2004,9:188-196
2．徐宝山,胡永成,唐天驷等.经皮椎体后凸成形术在脊椎溶骨性肿瘤中的应用.中华骨科杂志,2004,24(2)：97
3. Tomita K, Kawahara N, Kobayashi T, et al. Surgical strategy for spinal metastases[J]. Spine,2001.26(3):298-300
4. Tokuhashi Y, Matsuzaki H, Oda H, et al. A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis[J]. Spine, 2005.30(19):2186-2191
5.徐跃根,杨亚东,经皮椎体畸形后凸成形术治疗脊椎溶骨性转移瘤.浙江临床医学,2007年4月第9卷第4期：441-442
6.汤小东、郭卫等,手术联合椎体成形术治疗多发性脊柱肿瘤.中华外科杂志,2005年2月第43卷第4期：225-228
7. Belkoff SM, Molloy S. Temperature measurement during polymerization of polymethylmethacrylate cement used for vertebroplasty[J]. Spine,2003,28 (14):1555-1559
8. Barr JD, Barr MS, Lemley TJ, et al Percutaneous vertebroplasty for pain relief and spinal stabilization [J] Spine,2000,25 (8):923-928
9. Togawa D, Kovacic JJ, Bauer TW, et al. Radiographic and histologic findings of vertebral augmentation using polymethylmethacrylate in the primate spine:percutaneous vertebroplasty versus kyphoplasty[J]Spine,2006,31(1):E4-101
10. Togawa D, Bauer TW, Lieberman IH, et al. Histologic evaluation of human vertebral bodies after vertebral augmentation with polymethylmethacrylate[J] Spine,2003,28(14):1521-1527
11. San Millan Ruz D, Burkhardt K, Jean B, et al. Pathology findings with acrylic implants[J]. Bone,1999,25(Suppl):85-90
12. Togawa D, Kovacic JJ, Bauer TW, et al. Radiographic and histologic findings of vertebral augmentation using polymethylmethacrylate in the primate spine:percutaneous vertebroplasty versus kyphoplasty[J]Spine, 2006,31(1):E4-101
13. Gangi A, Guth S, Imbert JP, et al. Pereutaneons vertebroplasty: indications, technique, and results. Radiographics,2003,23:e10
14. Akio H, Toshio M, Yuji N, et al. Increase in vertebral body height after vertebroplasty. AJNR AmJ Neuroradiol,2003,23:185-189
15.邓刚,何士诚,滕皋军等,经皮椎体成形治疗脊柱恶性肿瘤[J].介入放射学杂志,2005,14：261-265.
16. Ahn H, Mousavi P, Chin L, et al. The effect of prevertebroplasty tumor ablation using laser-induced thermotherapy on biomechanieal stability and cement fill in the metastatic spine[J]. Eur Spine J,2007,16:1171-1178
17. Yamada K, Matsumoto Y, Kita M, et al. Long-term pain relief efects in four patients undergoing pereutaneous vertebroplasty for metastatic vertebral tumor[J]. J Anesth,2004,18:292-295.
18.汪建华,王振堂等,CT引导下经皮椎体成形术治疗颈椎转移瘤的临床应用.介入放射学杂志,2009年2月第18卷第2期JIntervent Radiol2009,Vol.18,No.2108-112
19. Sun K, Liebschner MA. Biomechanics of prophylactic vertebral reinforcement. Spine,2004,29:1428-1435
20. Belkoff SM, Mathis JM, Jasper LE, et al. Biomechanics of Vertebroplasty:the effect of cement volume on mechanic behave. Spine, 2001.26:1537-1541.
21. Liebschner MA, RosenbergWS, Keaveny TM. Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty[J]. Spine, 2001,26 (14):1547-1554.
22. Dean JR, Ison KT, Gishen P. Strengthening effect of percutaneous vertebroplasty. Clin Radiol,2000,55:471-476
23. Lewis G. Injectable bone cements for use in vertebroplasty and kyphoplasty:state-of-the-art review [J] Biomed Mater ResB Apply Biomater,2006,76 (2):456-468
24. Ledlie JT, Renfro M Balloon kyphoplasty:one-year outcomes in vertebral body height restoration, chronic pain, and activity levels [J] J Neurosurg,2003,98 (1 Supp 1):36-42
25. Lieberman IH, Dudeney S, Reinhardt MK, et al. Initial outcome and efficacy of "kyphoplasty" in the treatment of painful osteoporotic vertebral compression fractures[J]Spine,2001,26(14):1631-1638
26. Tohmeh AG, Mathis JM, Fenton DC, et al. Biomechanical efficacy of unipedicular versus bipedicular vertebroplasty for the management of osteoporotic fractures[J]. Spine,1999; 24(27):1772-1776.
27. Steinmann J, Tingey CT, Gruz G, et al. Biomechanical comparison of unipedicular versus bipedicular Kyphoplasty[J]. Spine,2005; 30(2): 201-205.
28.张亮,陈统一,陈中伟等,经单或双侧椎弓根灌注自固化磷酸钙骨水泥成形的效果比较[J].中国脊柱脊髓杂志,2005；15(9)：549-552.
29.Cotton A, Dewatre F, Cortet B, et al. Percutaneous vertebroplasty for osteolytic metastases and myeloma:effects of the percentage of lesion filling and the leakage of methylmethacrylate at clinical follow up. Radiology,1996,200:525-530
30.郑召民,李佛保,经皮椎体成形术和经皮椎体后凸成形术——问题与对策.中华医学杂志,2006年7月18日第86卷第27期1878-1880
31. Shimony JS, Gilula LA, Zeller AJ, et al. Pereutaneous vertebroplasty for malignant compression fractures with epidural involvement. Radiology,2004,232:846-853
32.杨荣利,郭卫等,开放性椎体成形术治疗脊柱转移瘤和多发性骨髓瘤.中华骨科杂志,2008年12月第28卷第12期：1028-1032
33. Heran MK, Legiehn GM, Munk PL. Current concepts and techniques in percutaneous vertebroplasty [J]. Orthop Clin North Am,2006,37(3):409-434
1.Klimo P Jr, Schmidt MH. Surgical management of spinal metastases. Oncologist,2004,9:188-196.
2.徐宝山,胡永成,唐天驷等.经皮椎体后凸成形术在脊椎溶骨性肿瘤中的应用.中华骨科杂志,2004,24(2)：97.
3. Schuster JM, Grady MS. Medical management and adjuvant thempies in spinal metastatic disease. Neurosurg Focus,2001,11:e3
4. Tomita K、Kawahara N, Kobayashi T, et al. Surgical strategy for spinal metastases[J]. Spine.2001.26(3):298-300
5. Tokuhashi Y. Matsuzaki H, Oda H, et al. A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis[J]. Spine, 2005.30(19):2186-2191.
6.徐跃根,杨亚东,经皮椎体畸形后凸成形术治疗脊椎溶骨性转移瘤.浙江临床医学,2007年4月第9卷第4期：441-442.
7.李志军,温树正等,椎弓根骨质的CT断面测量及其临床意义.中国临床解剖学杂志,2003年第21卷第1期：37-40
8. Panjabi MM, Shin EK, Chen NC, et al. Internal morphology of human cervical pedicles[J]. Spine,2000,25(10):1197-1205
9.王欢喜,邓展生,向铁成等,胸椎弓根及其周围神经解剖关系的研究[J].湘南学院学报(自然科学版),2005,7(4)：8-10
10. Zindrick MR, Wiltse LL, Doornik A, et al. Analysis of the morphometric characteristic of the thoracic and lumbar pedicles. [J] Spine,1987,12(2)：162-166
11.严军,宦坚,郑祖根等,上中胸椎椎弓根-肋单位的CT测量及临床意义.中国临床解剖学杂志,2007年第25卷第6期：636-639
12.侯树勋,史亚民,国人下胸椎及腰椎椎弓根形态学特点及临床意义.中华骨科杂志,1994年4月第14卷第4期：222-225
13.王欢喜,邓展生,向铁成等,腰椎椎弓根外缘和腰神经根关系的解剖研究.中国医学工程,2005年8月第13卷第4期：373-374
14. EBRAHEIM NA, JABALYG, XUR, Yeasting R A. Anatomic relations of the thoracic pedicle to the adjacent neural structure [J]. Spine,1997,22: 1553-1557.
15. Moran JM, Berg WS, Berry 儿 et al. Transpedicular screw fixation [J]. J Orthop Res,1989,7(1):107-114
16. Kothe R,O'Holleran JD,Liu W, et al. Internal architecture of the thoracic pedicle. An anatomic study[J]. Spine,1996,2(3)1:264-270
17.石锐,刘浩等,不同节段椎弓根内部结构的测量和比.CHINESE JOURNAL OF CLINICAL ANATOMY, VOL.23 NO.5 2005:458-462
18.徐志强、邓忠良等,椎弓根基底部穿刺角度的测量和临床意义.重庆医科大学学报,2007年第32卷第7期735-738
19. Mathis JM, Deramond H, Blekoff SM. Percutaneous vertebroplasty and kyphoplasty[M].2nd ed. New York:Springer-verlag New York, Inc,2006: 3-5.
20. J Steinmann, CT Tingey, G Cruz, and Q Dai Biomechanical comparison of unipedicular versus bipedicular kyphoplasty. Spine (Phila Pa 1976), January 15,2005; 30(2):201-5.
21.宓士军,吴立明,基于影像学测量的椎体成形但侧入路穿刺进针点和穿刺路径.中国组织工程研究与临床康复,2009第13卷第17期；3237-3240
22. Lewis G Injectable bone cements for use in vertebroplasty and kyphoplasty:state-of-the-art review [J] J Biomed Mater ResB App 1 Biomater,2006,76 (2):456-468
23.Ledlie JT, Renfro M Balloon kyphoplasty:one-year outcomes in vertebral body height restoration, chronic pain, and activity levels [J] J Neurosurg,2003,98 (1 Supp 1):36-421
24. Lieberman IH, Dudeney S, Reinhardt MK, et al. Initial outcome and efficacy of " kyphop lasty" in the treatment of painful osteoporoti cvertebral compression fractures[J]Spine,2001,26(14):1631-1638
25. Barr JD, Barr MS, Lemley TJ, et al. Percutaneous vertebroplasty for pain relief and spinal stabilization [J] Spine,2000,25 (8):923-928 26. Togawa D, Kovacic JJ, Bauer TW, et al. Radiographic and histologic findings of vertebral augmentation using polymethylmethacrylate in the primate spine:percutaneous vertebroplasty versus kyphoplasty [J] Spine, 2006,31(1):E4-101
27. Togawa D, Bauer TW, Lieberman IH, et al. Histologic evaluation of human vertebral bodies after vertebral augmentation with polymethylmethacrylate [J] Spine,2003,28(14):1521-1527.
28. San Millan Ruz D, Burkhardt K, Jean B, et al. Pathology findings with acrylic implants[J]. Bone,1999,25(Suppl):85-90.
29.陈珑、倪方才、刘一之等,硫酸钡为助显剂行经皮椎体成形术实验与初步临床应用.中国医学影像技术,2005年第21卷第7期1085-1088
30.孙诚张贵祥等,骨水泥中表阿霉素的释放及活性研究.实用放射学杂,1997年5月第13卷第5期：260-262
31.陆军、张贵祥等,CT引导下PVP携带化疗药物治疗脊柱转移瘤J Fourth Mil Med Univ,2002:23 (24):2271-2274
32. Sun K, Liebschner MA. Biomechanics of prophylactic vertebral reinforcement. Spine,2004,29:1428-1435
33. Belkoff SM, Mathis JM. Jasper LE, et al. Biomechanics of Vertebroplasty:the effect of cement volume on mechanic behave. Spine, 2001.26:1537-1541.
34. Gangi A, Guth S, Imbert JP, et al. Pereutaneons vertebroplasty: indications, technique, and results. Radiographics,2003,23:e10
35. Akio H, Toshio M, Yuji N, et al. Increase in vertebral body height after vertebroplasty. AJNR AmJ Neuroradiol,2003,23:185-189.
36. Molloy S, Mathis JM, Belkoff SM. The effect of vertebral body percentage fill on mechanical behavior during percutaneous vertebroplasty[J]. Sp ine,2003,28 (14):1549-1554.
37.Cotten A, Dewatre F, Cortet B, et al. Percutaneous vertebroplasty for osteolytic metastases and myeloma:effects of the percentage of lesion filling and the leakage of methylmethacrylate at clinical follow up. Radiology,1996,200:525-530
38.简志训,陈政行等,椎体成形术中不同骨水泥容量及位置的生物力学评估.中华创伤骨科杂志,2005年10月第7卷第10期：903-907
39. Liebschner MA, RosenbergWS, Keaveny TM. Effects of bone cement volume and distribution on vertebral stiffness after vertebrop lasty[J]. Spine, 2001,26 (14):1547-1554.
40.郑召民、李佛保,经皮椎体成形术和经皮椎体后凸成形术——问题与对策.中华医学杂志,2006年7月18日第86卷第27期1878-1880
41.刘绪力,雷伟等,椎体模型内模拟注射PMMA的流动及分布规律.第四军医大学学报,2007,28(2)：143-145)
42.邓刚,何士诚,滕皋军等,经皮椎体成形治疗脊柱恶性肿瘤[J].介入放射学杂志,2005,14：261-265.
43. Ahn H, Mousavi P, Chin L, et al. The effect of pre-vertebroplasty tumor ablation using laser-induced thermotherapy on biomeehanieal stability and cement fill in the metastatic spine [J]. Eur Spine J,2007,16:1171-1178
44. Yamada K, Matsumoto Y, Kita M, et al. Long-term pain relief efects in four patients undergoing pereutaneous vertebroplasty for metastatic vertebral tumor[J]. J Anesth,2004,18:292-295.
45.汪建华,王振堂等,CT引导下经皮椎体成形术治疗颈椎转移瘤的临床应用.介入放射学杂志,2009年2月第18卷第2期J Intervent Radiol 2009, Vol.18, No.2108-112
46.杨新建,林欣等,经皮椎体成形术治疗椎体恶性肿瘤(附23例报告).中华神经外科杂志,2005年7月第21卷第7期：412-415
47. Heran MK, Legiehn GM, Munk PL, Current concepts and techniques in percutaneous vertebroplasty [J]. Orthop Clin North Am,2006,37 (3):409-434 48. Chavali R, Resijek R, Knight SK, et al. Extending polymerization time of polymethylmethacrylate cement in percutaneous vertebroplasty with ice bath coling. AJNR Am J Neuroradiol,2003.24:545.546.
2．徐宝山,胡永成,唐天驷等.经皮椎体后凸成形术在脊椎溶骨性肿瘤中的应用.中华骨科杂志,2004,24(2)：97
3. Tomita K, Kawahara N, Kobayashi T, et al. Surgical strategy for spinal metastases[J]. Spine,2001.26(3):298-300
4. Tokuhashi Y, Matsuzaki H, Oda H, et al. A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis[J]. Spine, 2005.30(19):2186-2191
5.徐跃根,杨亚东,经皮椎体畸形后凸成形术治疗脊椎溶骨性转移瘤.浙江临床医学,2007年4月第9卷第4期：441-442
6.汤小东、郭卫等,手术联合椎体成形术治疗多发性脊柱肿瘤.中华外科杂志,2005年2月第43卷第4期：225-228
7. Belkoff SM, Molloy S. Temperature measurement during polymerization of polymethylmethacrylate cement used for vertebroplasty[J]. Spine,2003,28 (14):1555-1559
8. Barr JD, Barr MS, Lemley TJ, et al Percutaneous vertebroplasty for pain relief and spinal stabilization [J] Spine,2000,25 (8):923-928
9. Togawa D, Kovacic JJ, Bauer TW, et al. Radiographic and histologic findings of vertebral augmentation using polymethylmethacrylate in the primate spine:percutaneous vertebroplasty versus kyphoplasty[J]Spine,2006,31(1):E4-101
10. Togawa D, Bauer TW, Lieberman IH, et al. Histologic evaluation of human vertebral bodies after vertebral augmentation with polymethylmethacrylate[J] Spine,2003,28(14):1521-1527
11. San Millan Ruz D, Burkhardt K, Jean B, et al. Pathology findings with acrylic implants[J]. Bone,1999,25(Suppl):85-90
12. Togawa D, Kovacic JJ, Bauer TW, et al. Radiographic and histologic findings of vertebral augmentation using polymethylmethacrylate in the primate spine:percutaneous vertebroplasty versus kyphoplasty[J]Spine, 2006,31(1):E4-101
13. Gangi A, Guth S, Imbert JP, et al. Pereutaneons vertebroplasty: indications, technique, and results. Radiographics,2003,23:e10
14. Akio H, Toshio M, Yuji N, et al. Increase in vertebral body height after vertebroplasty. AJNR AmJ Neuroradiol,2003,23:185-189
15.邓刚,何士诚,滕皋军等,经皮椎体成形治疗脊柱恶性肿瘤[J].介入放射学杂志,2005,14：261-265.
16. Ahn H, Mousavi P, Chin L, et al. The effect of prevertebroplasty tumor ablation using laser-induced thermotherapy on biomechanieal stability and cement fill in the metastatic spine[J]. Eur Spine J,2007,16:1171-1178
17. Yamada K, Matsumoto Y, Kita M, et al. Long-term pain relief efects in four patients undergoing pereutaneous vertebroplasty for metastatic vertebral tumor[J]. J Anesth,2004,18:292-295.
18.汪建华,王振堂等,CT引导下经皮椎体成形术治疗颈椎转移瘤的临床应用.介入放射学杂志,2009年2月第18卷第2期JIntervent Radiol2009,Vol.18,No.2108-112
19. Sun K, Liebschner MA. Biomechanics of prophylactic vertebral reinforcement. Spine,2004,29:1428-1435
20. Belkoff SM, Mathis JM, Jasper LE, et al. Biomechanics of Vertebroplasty:the effect of cement volume on mechanic behave. Spine, 2001.26:1537-1541.
21. Liebschner MA, RosenbergWS, Keaveny TM. Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty[J]. Spine, 2001,26 (14):1547-1554.
22. Dean JR, Ison KT, Gishen P. Strengthening effect of percutaneous vertebroplasty. Clin Radiol,2000,55:471-476
23. Lewis G. Injectable bone cements for use in vertebroplasty and kyphoplasty:state-of-the-art review [J] Biomed Mater ResB Apply Biomater,2006,76 (2):456-468
24. Ledlie JT, Renfro M Balloon kyphoplasty:one-year outcomes in vertebral body height restoration, chronic pain, and activity levels [J] J Neurosurg,2003,98 (1 Supp 1):36-42
25. Lieberman IH, Dudeney S, Reinhardt MK, et al. Initial outcome and efficacy of "kyphoplasty" in the treatment of painful osteoporotic vertebral compression fractures[J]Spine,2001,26(14):1631-1638
26. Tohmeh AG, Mathis JM, Fenton DC, et al. Biomechanical efficacy of unipedicular versus bipedicular vertebroplasty for the management of osteoporotic fractures[J]. Spine,1999; 24(27):1772-1776.
27. Steinmann J, Tingey CT, Gruz G, et al. Biomechanical comparison of unipedicular versus bipedicular Kyphoplasty[J]. Spine,2005; 30(2): 201-205.
28.张亮,陈统一,陈中伟等,经单或双侧椎弓根灌注自固化磷酸钙骨水泥成形的效果比较[J].中国脊柱脊髓杂志,2005；15(9)：549-552.
29.Cotton A, Dewatre F, Cortet B, et al. Percutaneous vertebroplasty for osteolytic metastases and myeloma:effects of the percentage of lesion filling and the leakage of methylmethacrylate at clinical follow up. Radiology,1996,200:525-530
30.郑召民,李佛保,经皮椎体成形术和经皮椎体后凸成形术——问题与对策.中华医学杂志,2006年7月18日第86卷第27期1878-1880
31. Shimony JS, Gilula LA, Zeller AJ, et al. Pereutaneous vertebroplasty for malignant compression fractures with epidural involvement. Radiology,2004,232:846-853
32.杨荣利,郭卫等,开放性椎体成形术治疗脊柱转移瘤和多发性骨髓瘤.中华骨科杂志,2008年12月第28卷第12期：1028-1032
33. Heran MK, Legiehn GM, Munk PL. Current concepts and techniques in percutaneous vertebroplasty [J]. Orthop Clin North Am,2006,37(3):409-434
1.Klimo P Jr, Schmidt MH. Surgical management of spinal metastases. Oncologist,2004,9:188-196.
2.徐宝山,胡永成,唐天驷等.经皮椎体后凸成形术在脊椎溶骨性肿瘤中的应用.中华骨科杂志,2004,24(2)：97.
3. Schuster JM, Grady MS. Medical management and adjuvant thempies in spinal metastatic disease. Neurosurg Focus,2001,11:e3
4. Tomita K、Kawahara N, Kobayashi T, et al. Surgical strategy for spinal metastases[J]. Spine.2001.26(3):298-300
5. Tokuhashi Y. Matsuzaki H, Oda H, et al. A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis[J]. Spine, 2005.30(19):2186-2191.
6.徐跃根,杨亚东,经皮椎体畸形后凸成形术治疗脊椎溶骨性转移瘤.浙江临床医学,2007年4月第9卷第4期：441-442.
7.李志军,温树正等,椎弓根骨质的CT断面测量及其临床意义.中国临床解剖学杂志,2003年第21卷第1期：37-40
8. Panjabi MM, Shin EK, Chen NC, et al. Internal morphology of human cervical pedicles[J]. Spine,2000,25(10):1197-1205
9.王欢喜,邓展生,向铁成等,胸椎弓根及其周围神经解剖关系的研究[J].湘南学院学报(自然科学版),2005,7(4)：8-10
10. Zindrick MR, Wiltse LL, Doornik A, et al. Analysis of the morphometric characteristic of the thoracic and lumbar pedicles. [J] Spine,1987,12(2)：162-166
11.严军,宦坚,郑祖根等,上中胸椎椎弓根-肋单位的CT测量及临床意义.中国临床解剖学杂志,2007年第25卷第6期：636-639
12.侯树勋,史亚民,国人下胸椎及腰椎椎弓根形态学特点及临床意义.中华骨科杂志,1994年4月第14卷第4期：222-225
13.王欢喜,邓展生,向铁成等,腰椎椎弓根外缘和腰神经根关系的解剖研究.中国医学工程,2005年8月第13卷第4期：373-374
14. EBRAHEIM NA, JABALYG, XUR, Yeasting R A. Anatomic relations of the thoracic pedicle to the adjacent neural structure [J]. Spine,1997,22: 1553-1557.
15. Moran JM, Berg WS, Berry 儿 et al. Transpedicular screw fixation [J]. J Orthop Res,1989,7(1):107-114
16. Kothe R,O'Holleran JD,Liu W, et al. Internal architecture of the thoracic pedicle. An anatomic study[J]. Spine,1996,2(3)1:264-270
17.石锐,刘浩等,不同节段椎弓根内部结构的测量和比.CHINESE JOURNAL OF CLINICAL ANATOMY, VOL.23 NO.5 2005:458-462
18.徐志强、邓忠良等,椎弓根基底部穿刺角度的测量和临床意义.重庆医科大学学报,2007年第32卷第7期735-738
19. Mathis JM, Deramond H, Blekoff SM. Percutaneous vertebroplasty and kyphoplasty[M].2nd ed. New York:Springer-verlag New York, Inc,2006: 3-5.
20. J Steinmann, CT Tingey, G Cruz, and Q Dai Biomechanical comparison of unipedicular versus bipedicular kyphoplasty. Spine (Phila Pa 1976), January 15,2005; 30(2):201-5.
21.宓士军,吴立明,基于影像学测量的椎体成形但侧入路穿刺进针点和穿刺路径.中国组织工程研究与临床康复,2009第13卷第17期；3237-3240
22. Lewis G Injectable bone cements for use in vertebroplasty and kyphoplasty:state-of-the-art review [J] J Biomed Mater ResB App 1 Biomater,2006,76 (2):456-468
23.Ledlie JT, Renfro M Balloon kyphoplasty:one-year outcomes in vertebral body height restoration, chronic pain, and activity levels [J] J Neurosurg,2003,98 (1 Supp 1):36-421
24. Lieberman IH, Dudeney S, Reinhardt MK, et al. Initial outcome and efficacy of " kyphop lasty" in the treatment of painful osteoporoti cvertebral compression fractures[J]Spine,2001,26(14):1631-1638
25. Barr JD, Barr MS, Lemley TJ, et al. Percutaneous vertebroplasty for pain relief and spinal stabilization [J] Spine,2000,25 (8):923-928 26. Togawa D, Kovacic JJ, Bauer TW, et al. Radiographic and histologic findings of vertebral augmentation using polymethylmethacrylate in the primate spine:percutaneous vertebroplasty versus kyphoplasty [J] Spine, 2006,31(1):E4-101
27. Togawa D, Bauer TW, Lieberman IH, et al. Histologic evaluation of human vertebral bodies after vertebral augmentation with polymethylmethacrylate [J] Spine,2003,28(14):1521-1527.
28. San Millan Ruz D, Burkhardt K, Jean B, et al. Pathology findings with acrylic implants[J]. Bone,1999,25(Suppl):85-90.
29.陈珑、倪方才、刘一之等,硫酸钡为助显剂行经皮椎体成形术实验与初步临床应用.中国医学影像技术,2005年第21卷第7期1085-1088
30.孙诚张贵祥等,骨水泥中表阿霉素的释放及活性研究.实用放射学杂,1997年5月第13卷第5期：260-262
31.陆军、张贵祥等,CT引导下PVP携带化疗药物治疗脊柱转移瘤J Fourth Mil Med Univ,2002:23 (24):2271-2274
32. Sun K, Liebschner MA. Biomechanics of prophylactic vertebral reinforcement. Spine,2004,29:1428-1435
33. Belkoff SM, Mathis JM. Jasper LE, et al. Biomechanics of Vertebroplasty:the effect of cement volume on mechanic behave. Spine, 2001.26:1537-1541.
34. Gangi A, Guth S, Imbert JP, et al. Pereutaneons vertebroplasty: indications, technique, and results. Radiographics,2003,23:e10
35. Akio H, Toshio M, Yuji N, et al. Increase in vertebral body height after vertebroplasty. AJNR AmJ Neuroradiol,2003,23:185-189.
36. Molloy S, Mathis JM, Belkoff SM. The effect of vertebral body percentage fill on mechanical behavior during percutaneous vertebroplasty[J]. Sp ine,2003,28 (14):1549-1554.
37.Cotten A, Dewatre F, Cortet B, et al. Percutaneous vertebroplasty for osteolytic metastases and myeloma:effects of the percentage of lesion filling and the leakage of methylmethacrylate at clinical follow up. Radiology,1996,200:525-530
38.简志训,陈政行等,椎体成形术中不同骨水泥容量及位置的生物力学评估.中华创伤骨科杂志,2005年10月第7卷第10期：903-907
39. Liebschner MA, RosenbergWS, Keaveny TM. Effects of bone cement volume and distribution on vertebral stiffness after vertebrop lasty[J]. Spine, 2001,26 (14):1547-1554.
40.郑召民、李佛保,经皮椎体成形术和经皮椎体后凸成形术——问题与对策.中华医学杂志,2006年7月18日第86卷第27期1878-1880
41.刘绪力,雷伟等,椎体模型内模拟注射PMMA的流动及分布规律.第四军医大学学报,2007,28(2)：143-145)
42.邓刚,何士诚,滕皋军等,经皮椎体成形治疗脊柱恶性肿瘤[J].介入放射学杂志,2005,14：261-265.
43. Ahn H, Mousavi P, Chin L, et al. The effect of pre-vertebroplasty tumor ablation using laser-induced thermotherapy on biomeehanieal stability and cement fill in the metastatic spine [J]. Eur Spine J,2007,16:1171-1178
44. Yamada K, Matsumoto Y, Kita M, et al. Long-term pain relief efects in four patients undergoing pereutaneous vertebroplasty for metastatic vertebral tumor[J]. J Anesth,2004,18:292-295.
45.汪建华,王振堂等,CT引导下经皮椎体成形术治疗颈椎转移瘤的临床应用.介入放射学杂志,2009年2月第18卷第2期J Intervent Radiol 2009, Vol.18, No.2108-112
46.杨新建,林欣等,经皮椎体成形术治疗椎体恶性肿瘤(附23例报告).中华神经外科杂志,2005年7月第21卷第7期：412-415
47. Heran MK, Legiehn GM, Munk PL, Current concepts and techniques in percutaneous vertebroplasty [J]. Orthop Clin North Am,2006,37 (3):409-434 48. Chavali R, Resijek R, Knight SK, et al. Extending polymerization time of polymethylmethacrylate cement in percutaneous vertebroplasty with ice bath coling. AJNR Am J Neuroradiol,2003.24:545.546.