评估利用CT结合C臂透视引导行经皮椎体成形术治疗疼痛性颈椎椎体转移癌的临床可行性、安全性及疗效。

采用CT结合C臂透视引导经皮椎体成形术，治疗10例疼痛性颈椎转移癌患者的11个病变椎体，其中C3和C6各3个，C5和C7各2个，C4椎体1个。在CT引导下以18 G穿刺针穿刺进入靶椎体内，然后将患者移至DSA机诊疗床上，在透视监控下注射聚甲基丙烯酸甲酯骨水泥于病变椎体内，记录术中骨水泥用量及PVP相关并发症。记录患者术前、术后1周、术后1个月及3个月疼痛评分，采用重复测量的方差分析检验治疗前后各时间点的患者疼痛评分有无差异。

所有患者病变椎体穿刺和骨水泥注射都取得了成功。每个椎体的骨水泥平均注射量为1.7±0.3 mL（1.2～2.2 mL），所有患者的疼痛都得到了明显缓解。患者术前、术后1周、术后1个月及3个月疼痛评分分别为8.3±0.7，3.0±0.7，2.7±0.5，3.0±0.6，差异有统计学意义（F = 215.705，P < 0.05）。除3个椎体发生无症状的骨水泥渗漏外，无一例发生严重并发症。

CT结合C臂透视引导行经皮椎体成形术治疗疼痛性颈椎转移癌安全、有效、可行。

To investigate the clinical safety, efficacy and feasibility of percutaneous vertebroplasty (PVP) guided by CT and C-arm fluoroscopy for the treatment of painful cervical metastasis.

PVP was performed under CT and C-arm guidance in 10 patients with painful cervical metastases. A total of 11 diseased vertebral bodies were detected, which distributed in the C3 (n = 3), C4 (n = 1), C5 (n = 2), C6 (n = 3) and C7 (n = 2). Under CT guidance, an 18G needle was punctured into the target vertebral body, and then the patient was moved to a C-arm digitalized angiographic system. Polymethylmethacrylate bone cement was injected into the vertebral body under constant lateral fluoroscopy with the C-arm fluoroscopy system. Under C-arm fluoroscopy monitoring,vertebral bodies were injected polymethyl methacrylate bone cement.The amount of bone cement used during PVP and any complications related with PVP were recorded. The score of visual analogue scale point (VAS) before PVP, 1 week, 1 and 3 months after PVP was recorded respectively. The difference of VAS score between the different time points was analyzed using repeated measures of ANOVA.

The technical success of both needle puncturing and bone cement injection was achieved in all patients. The mean amount of bone cement injected in each diseased vertebra was 1.7 ± 0.3 mL(1.2~2.2 mL). Marked pain relief was quickly obtained in all 10 patients. The VAS score before PVP, 1 week, 1 month and 3 months after PVP was 8.3 ± 0.7, 3.0 ± 0.7, 2.7 ± 0.5, 3.0 ± 0.6, respectively ,and the VAS score after PVP decreased significantly compared to the pre-treatment (F = 215.705, P < 0.05). No major complications occurred in this series, except for asymptomatic bone cement leaking around vertebra which appeared in 3 vertebral bodies.

Percutaneous vertebroplasty guided by CT and C-arm is a safe and effective technique for the treatment of painful cervical vertebral body metastasis.