椎板减压联合射频消融辅助椎体成形术治疗肺癌脊柱转移的临床研究

Posterior laminectomy and vertebroplasty combined with radiofrequency ablation in spinal metastases from lung cancer

目的探讨肺癌脊柱转移患者进行椎板减压联合射频消融辅助椎体成形术的安全性和有效性。方法11例肺癌脊柱转移患者均行椎板减压联合射频消融辅助椎体成形术治疗。术中先行后路椎板减压,在开放手术下对病变椎体射频消融后行椎体成形术,所有患者均行脊柱内固定,记录手术时间及术中出血量,统计骨水泥渗漏率。于术前、术后1月,应用视觉模拟评分(visual analogue scale,VAS)评估疼痛、Frankel分级评估脊髓损伤、卡式(Karnofsky,KPS)评分系统评估功能状态,统计二便恢复情况,应用EORTC QLQ-C30评分评估生活质量。结果手术时间平均为(150.00±99.21)分钟,术中出血量平均为(410.00±102.23)mL,骨水泥渗漏率为27.3%。术后1月疼痛(VAS评分)较术前明显缓解(P<0.01)。术后1月,患者Frankel分级D、E级由术前的45.5%提高到81.8%。KPS评分(80～100)由术前的36.4%提高到72.7%。术前二便障碍的患者术后有55.6%(5/9)得到不同程度缓解。术前EORTC QLQ-C30评分为(84.09±9.48)分,术后为(54.64±15.17)分,患者生活质量明显提高(P<0.01)。结论椎板减压联合射频消融辅助椎体成形术治疗肺癌脊柱转移手术时间短、出血量少、骨水泥渗漏率低,能明显减轻患者疼痛、改善脊髓损伤和功能状态,部分患者二便功能得以恢复,生存质量得到明显提高。

Objective To investigate the safety and efficacy of laminectomy and vertebroplasty with radiofrequency ablation in spinal metastases from lung cancer. Methods Clinical data of 11 cases with spinal metastases from lung cancer were retrospectively analyzed. AU received posterior laminectomy to relieve the compression of spinal cord, and vertebruplasty combined with radiofrequency ablation （RFA） was performed, followed by instrumented fixation. The operative time, the blood loss and the rate of bone cement leakage were analyzed. The pain levels before and 1 month after operation were assessed by visual analogue scale （VAS）; the neurological deficit was evaluated by Frankel grade and the functional impairment was classified by Karnofsky score. The quality of life was assessed by EORTC QLQ- c30 questionnaire. Results The mean operative time was （ 150 ± 99.21 ） min. The blood loss was （410.00 ± 102.23）mL. The rate of bone cement leakage was 27.3%. The VAS at 1 month after operation was improved compared to preoperative VAS（P 〈0.01 ）. The rate of Frankel grade D or E in patients was increased from 45.5% to 81.8% after operation; the rate of KPS score （ 80 - 100） increased from 36.4% to 72.7% after operation, including 5 out of 9 patients whose sphincteric dysfunction was improved. The EORTC QLQ-C30 scores were 84.09 ＋ 9.48 and 54.64 -＋ 15.17 before and after operation, respectively （ P 〈 0.01 ）. Conclusion Posterior laminectomy and vertebroplasty combined with radiofrequency ablation is safe and effective. It can release pain, improve function and quality of life in lung cancer patients with spinal metastases.