两种经皮椎体成形术治疗椎体肿瘤的比较

Comparison Study of Percutaneous Vertebroplasty(PVP) and Skyphoplasty for Treatment of Spinal Tumors

【目的】探讨应用经皮椎体成形术(PVP)和skyphoplasty(SKY)椎体成形术两种方法治疗椎体肿瘤患者的效果,对比其临床特点与差异。【方法】对2003年2月至2008年2月间采用两种经皮椎体成形手术方法治疗65例椎体肿瘤患者共87个椎体资料进行回顾性分析,其中PVP组29例,平均年龄55.2岁,共42个椎体;SKY组36例,平均年龄52.6岁,共45个椎体。PVP组穿刺后直接注射骨水泥,SKY组经膨胀扩张后再注射骨水泥。记录并评价术后疼痛缓解程度,并观察骨水泥渗漏情况。【结果】PVP组VAS评分由术前(7.79±1.25)分降为术后48 h的(1.86±0.33)分;SKY组VAS评分由术前(8.03±1.12)分降为术后48 h的(1.72±0.41)分,两组术后评分均显著低于术前(P<0.05)。PVP组总体优良率为86.2%,SKY组优良率为91.8%,两者差异无统计学意义。SKY组的骨水泥分布主要位于正位片椎体中央,侧位片椎体前2/3处;而PVP组骨水泥分布不规律,正位片偏穿刺侧分布为主。骨水泥渗漏及并发症发生率SKY组的骨水泥渗漏率为24.4%,低于PVP组的40.5%,两者差异有统计学意义(P<0.05)。【结论】两种经皮椎体成形方法都可以有效地缓解椎体肿瘤患者的疼痛,其中SKY椎体成形术在保证手术效果同时能明显地降低骨水泥渗漏的并发症发生。

[ Objective ] To evaluate the clinical efficacy and difference of the percutaneous vertebroplasty （PVP） and skyphoplasty （SKY） for the treatment of spinal tumors. [ Methods ] Between February 2003 and February 2008, 65 patients （87 vertebral bodies） with spinal tumors were treated by PVP and skyphoplasty. There were 29 patients with 42 levels in PVP group. The average age of the patients was 55.2 years old. In SKY group, there were 36 patients with 45 levels, the average age was 52.6 years old. In SKY group, the cases were injected cement into vertebral body after expanding the bone and in PVP group,the patients were injected the bone cement directly into vertebral body.Outcome data were obtained by comparing visual analog scale （VAS）.Preoperative and postoperative radiographs were analyzed to assess the leakage of bone cement. [Results] The VAS score was 7.79 -＋ 1.25 before operation and decreased to 1.86 ＋ 0.33 48 hours after operation in PVP group （P 〈 0.05）. In SKY group, the VAS score was 8.03-＋ 1.12 before operation and decreased to 1.72 -＋ 0.41 after operation （P 〈 0.05）. The excellent rate of PVP and Sky group was 86.2% and 91.8%, respectively. In SKY groups the bone cement were distributed in the center region of vertebral body. In the lateral view of X-ray, the cement was in the anterior two thirds of vertebral body. The distributing of bone cement in PVP group was irregular in the vertebral body. The rate of leakage complication in the SKY group was lower significantly compared with the PVP group （24.4% vs 40.5%, P 〈 0.05）. [Conclusion] Satisfactory clinical results can be achieved both by PVP and skyphoplasty for the treatment of patients with spinal tumors. Skyphoplasty have significant advantages in the complication rate of bone cement leakage.