椎间孔镜下射频消融治疗椎旁骨转移瘤患者顽固性疼痛的疗效观察

Reliving refractory pain of spinal metastasis patients with radiofrequency ablation through transforaminal endoscopy

目的探讨椎间孔镜下行射频消融缓解椎旁骨转移瘤患者疼痛的疗效。方法回顾分析2011年11月至2012年11月贵阳医学院附属贵州省肿瘤医院骨科应用椎间孔镜下行射频消融治疗的椎旁骨转移瘤患者手术后疼痛缓解的疗效的18例资料。通过VAS评分观察该手术后疼痛的缓解程度。其中，男8例，女10例；年龄32-76岁，中位年龄52．1岁。乳腺癌5例，前列腺癌3例，消化道肿瘤4例，甲状腺癌2例，肺癌4例。病程2-20个月，平均7．8个月。肿瘤侵犯单个节段椎体周围10例，2个及3个节段周围8例。Tomita分型：5型8例，6型4例，7型6例。合并病理性骨折2例。结果手术时间90-180min，平均118rain；术中出血量10-60m1，平均30．6ml；术后切口均I期愈合。术后1例患者并发肺炎，经抗炎治疗后缓解。术后疼痛的VAS评分：术后1d，1、2、4周的VAS评分分别为（2．4±0．4）、（2．6±0．6）、（3．0±0．3）、（2．8±0．7）分。手术前与手术后1d，1、2、4周时的VAS评分比较差异有统计学意义，均P〈0．01。结论椎间孔镜下转移性肿瘤的射频毁损可使患者疼痛得到缓解，并且该手术切口小，损伤小，出血少，对患者整体影响小，并发症发生率低。短期内患者疼痛缓解效果确切。

Objective To explore the short-term outcomes of radiofrequency ablation treatment of bone metastasis. Methods Between November 2011 and November 2012, a total of 18 cases were retrospectively reviewed. They underwent resection of bone metastasis with radiofrequency ablation through transforaminal endoscopic spine system. According to the Tomita classification system, the classifications were type 5 （n =8）, type 6 （n =4） and type 7 （n =6）. There were 8 males and 10 females with a median age of 52. 1 （32 - 76） years. The primary lesions were breast cancer （ n = 5 ）, carcinoma of prostate （ n = 3 ） , digestive cancer （ n = 4 ） , thyroid carcinoma （ n = 2 ） and lung cancer （ n = 4 ）. And two cases had pathologic fracture. Results The operative duration was 118 （90 - 180） min and blood loss volume 30. 6 （10 -60） ml. All incisions achieved excellent healing. One case of pneumonia recovered with antibiotic. The postoperative visual analogue scale （VAS） scores were 2. 4 ±0. 4, 2. 6±0. 6, 3.0 ±0. 3 and 2. 8 ±0. 7. Conclusion Radiofrequency ablation through transforaminal endoscopy may be a safe and efficacious option for refractory pain with bone metastasis, especially for those with uncontrolled pain. This procedure is mini-invasive and causes less bleedinz.