经皮椎体后凸成形术治疗胸腰椎溶骨性肿瘤短期疗效分析

Analysis in short-term clinical benefit of percutaneous kyphoplasty for treating osteolytic tumor of thoracic lumbar vertebrae

目的观察接受经皮椎体后凸成形术（PKP）治疗的胸腰椎溶骨性肿瘤患者疼痛及日常活动的改善情况。方法回顾性分析接受PKP治疗的胸腰椎溶骨性肿瘤患者35例，术前均有顽固性背痛，cT及MRI提示椎体溶骨眭病变。在C型臂下行椎弓根穿刺球囊扩张椎体后注射骨水泥，采用视觉模拟评分（VAS）、WHO疼痛缓解标准及Owestry功能障碍指数（ODI）于术后ld、1个月、6个月评估疼痛缓解及日常活动功能恢复情况，并对病椎的高度变化进行分析，记录骨水泥外漏情况。采用t检验进行统计学分析。结果35例患者术后24h内疼痛缓解，无脊髓或神经根损伤及压迫症状，复查x线片见椎体内骨水泥填充良好。手术前后VAS（7．52±0．81比4．31±0．32）、ODI（69．45±0．87比54．45±0．85）和病椎高度【（2．0±0．5）mm比（2．7±0．4）mm】比较，差异均有统计学意义（t值分别为-7.34、-5．32和-3．36，均P〈0．05）。术后随访6个月疼痛缓解及日常活动功能改善趋于稳定。术后1d、1个月、6个月疼痛缓解率分别为80．0％（28／35）、85．7％（30／35）及82．8％（29／35）。结论PKP能迅速缓解胸腰椎溶骨性肿瘤引起的疼痛，有效恢复病椎高度，并发症相对较少，提高患者生存质量。

Objective To evaluate the relief of pain and daily activities in patients with osteolytie tumor of thoracic lumbar vertebrae by pereutaneous kyphoplasty （PKP）. Methods A retrospective study was conducted to review 35 cases of osteolytic tumor of vertebrae treated with PKP. All patients had a refractories back pain while CT and MRI showed osteolytic changes in their vertebrae. The operation involved percutaneously inserting inflatable vertebral body and creating a cavity filled with bone cement. The visual analogue scales （VAS）, WHO standards for pain relief and owestry disability index （ODI） were recorded after the procedures. The change of height in abnormal vertebrae and status of postoperative leakage of PMMA were also recorded. These data were followed up after 1 day, 1 month and 6 months and analyzed via t student test. Results The total 35 operations were done successfully. All patients got a conspicuous pain relief at 24 h after operation, and no spinal injury or compression was found. The X-ray showed that the vertebrates treated were filled well by cement. There were significant differences at pain levels [（7.52±0.81） vs （4.31±0.32）], locomotor activity scales （ODI） [（69.45±0.87） vs （54.45±0.85）] and the height of vertebral bodies [（2.0±0.5） mm vs （2.7±0.4） mm] before and after operation （t value was -7.34, -5.32 and -3.36, respectively, P 〈 0.05）. At 6 months, follow up studies showed that clinic therapeutic effects were stabled for odynolysis and locomotor activity scales. The rates of pain relief in 24 h, 1 month and 6 months were 80.0 % （28/35）, 85.7 % （30/35）, 82.8 % （29/35）, respectively, Conclusion PKP is a single safe and effective way to treat osteolytic tumor of thoracic lumbar vertebrae. It can simply, quickly, and effectively relief the pain caused by osteolytic spinal tumor, recover height of the abnormal vertebra, and improve patient＇s life quality safely with less complications.