经皮骨水泥椎间融合术在椎体转移瘤治疗中的应用

Application of percutaneous bone cement intervertebral fusion in the treatment of vertebral metastases

目的探讨经皮骨水泥椎间融合术治疗病情严重椎体转移瘤患者的安全性及有效性。方法回顾性分析22例行经皮骨水泥椎间融合术的椎体转移瘤患者,手术通过经椎弓根或椎旁途径在病变椎体及相邻椎间盘内建立穿刺通道,随后向椎体及椎间盘内注入骨水泥,将2个或多个病变椎体融合形成一个整体,手术部位包括46个椎体,24个椎间盘,术后使用椎体骨水泥覆盖率评价骨水泥病灶填充情况,随访过程中采用视觉模拟评分(VAS评分)及Oswestry功能障碍指数(ODI指数)评价临床疗效,采用SPSS 22.0统计软件对随访数据进行统计学分析。结果所有患者顺利完成手术,椎体骨水泥灌注量为3～5 mL,平均(4.39±0.61) mL,椎间盘骨水泥灌注量为2～4 mL,平均(2.63±0.58) mL。部分患者水泥渗漏至椎体前缘周围组织,未引起明显不适。术后椎体水泥覆盖率评级为优的手术椎体44个(95.7%),评级为良的手术椎体2个(4.4%),评级为不足的手术椎体0个。术前VAS评分及ODI指数分别为:7.23±0.81,75.15±4.88。术后3 d,术后1、3和6个月的VAS及ODI指数分别为:4.77±1.02、2.86±0.71、2.50±0.51、2.59±0.80和57.88±12.78、38.59±7.84、35.35±7.78、35.86±10.09。所有患者术后相关评价指标较术前均有明显好转,2例(9.9%)患者随访过程中病情出现反复,但较术前均有一定改善。术前与术后评价指标的差异有统计学意义。结论对于经皮椎体成形术无法取得满意临床疗效的病情严重患者,经皮骨水泥椎间融合术是安全有效的治疗方法,以提高病灶骨水泥覆盖率,恢复患者脊柱稳定性,缓解疼痛,提高患者生活质量。

Objective To evaluate the safety and efficacy of percutaneous bone cement intervertebral fusion in treating severe vertebral metastases. Methods The clinical data of 22 patients with vertebral metastases, who were treated with percutaneous cement intervertebral fusion, were retrospective analyzed. A puncture passage in the diseased vertebral body and adjacent intervertebral discs was established via the pedicle or paravertebral pathway, which was followed by injecting bone cement into the vertebral body and intervertebral disc to fuse the two or more diseased vertebrae into a whole. A total of 46 vertebrae and 24 intervertebral discs were operated. The bone cement coverage rate was used to assess the filling degree of bone cement, the visual analogue score(VAS) and Oswestry dysfunction index(ODI) were used to evaluate the clinical efficacy, and the follow-up data were statistically analyzed by SPSS22.0 Software. Results Successful operation was achieved in all patients. The amount of cement injected into the vertebral body was3-5 mL, with a mean of(4.39±0.61) mL;the amount of cement injected into the intervertebral disk was 2-4 mL, with an average of(2.63±0.58) mL. Bone cement leakage into the tissue around the anterior edge of the vertebral body was observed in some patients, and the patients showed no obvious symptoms. Postoperative cement coverage rating of excellent degree was obtained in 44 vertebral bodies(95.65%), cement coverage rating of good degree in 2 vertebral bodies(4.35%), and cement coverage rating of inadequate degree in0 vertebral body. Preoperative VAS value and ODI value were(7.23±0.81) and(75.15±4.88) respectively.The VAS values and ODI values at 3 days, 1, 3 and 6 months after operation were(4.77±1.02),(2.86±0.71),(2.50±0.51),(2.59±0.80) and(57.88±12.78),(38.59±7.84),(35.35±7.78),(35.86±10.09) respectively.The related postoperative evaluation indexes were obviously improved when compared with the preoperative data. In 2 patients(9.9%), recurrence of disease was observed during follow-up period, but the patients’ condition was better than preoperative state. The differences in evaluating indicators between preoperative data and postoperative ones were statistically significant. Conclusion For patients with severe vertebral metastases, who can′ t get satisfactory clinical results from percutaneous vertebroplasty, percutaneous bone cement intervertebral fusion is a safe and effective treatment, which can improve bone cement coverage of lesions, restore spinal stability, relieve pain and improve the quality of life of patients.