经皮椎体成形术和椎体后凸成形术治疗多节段胸腰椎转移瘤疗效比较

The effect comparison of percutaneous vertebroplasty with kyphoplasty in the treatment of multi-segmental thoracic and lumbar spinal metastases

目的：比较射频消融术分别联合经皮椎体成形术（PVP）和椎体后凸成形术（PKP）治疗多节段胸腰椎转移瘤的临床疗效.方法：随机选取多节段胸腰椎转移瘤合并椎体压缩骨折患者112例,其中PVP组58例共83个病椎,行PVP治疗;PKP组54例共75个病椎,行PKP治疗.采用疼痛分级法评估2组术前和术后1d的疼痛程度;记录术后病椎高度、病椎前缘高度的恢复情况、骨水泥渗漏及是否出现渗血、血气胸等严重并发症,对比2组治疗前后的效果.结果：112例患者椎体穿刺均成功,术后随访12～24个月;2组术前视觉模拟评分差异均无统计学意义（P＞0.05）,PVP组和PKP组术后1d视觉模拟评分均较术前降低（P＜0.05）;术后1年PVP组椎体前缘平均高度恢复至正常的（79.85±4.21）％,PKP组为（95.23±2.05）％,差异有统计学意义（P ＜0.05）;PVP组术中骨水泥渗漏22例35个椎体,PKP组13例16个椎体,2组未出现渗血等严重并发症.结论：射频消融术分别联合PVP和PKP对多节段胸腰椎转移瘤治疗的镇痛效果均较好,并发症均较少,但PKP的复位效果好于PVP,且较少发生骨水泥渗漏;临床上应根据患者具体病情应用.

Objective：To compare the curative effects of radiofrequency ablation （RFA） combined with percutaneous vertebroplasty （PVP） and percutaneous kyphoplasty（PKP） in the treatment of multi-segmental thoracic and lumbar spinal metastases.Methods：One hundred and twelve patients with segmental metastases complicated with thoracolumbar vertebral compression fractures were randomly divided into the PVP group（58 cases,83 vertebras） and PKP group （54 cases,75 vertebras）,the PVP and PKP group were treated with PVP and PKP,respectively.The pain degrees in two groups were evaulated using verbal rating scale before treatment and at 1 day after treatment.The vertebral height recovery,bone cement leakage,bleeding and hemopneumothorax in two groups were recorded after the surgery.The curative effects between two goups were compared after treatment.Results：The vertebral punctures in 112 patients were successful,all cases were followed up for 12 to 24 months.The difference of visual analoglle scales scores before surgery in two groups was not statistically signficant（P ＞0.05）,the difference of visual analoglle scales scores of two groups between before surgery and at 1 day after surgery was statistically signficant （P ＜ 0.05）.The heights of anterior vertebral body in PVP group and PKP group at 1 year after surgery rose to（79.85 ± 4.21） ％ and （95.23 ± 2.05） ％ of the normal average height,respectively,the difference of which was statistically signficant （P ＜ 0.05）.The bone cement leakage in PVP group 22 cases（35 vertebras） and in PKP group 13 cases（16 vertebras）.No bleeding case in two groups was found.Conclusions：The radiofrequency ablation combined with PVP and PKP for treating multi-segmental thoracic lumbar spinal metastases is good effects and less complications.The reduction effects of PKP are better than that of PVP,the PKP treatment is less leakage of bone cement.Treatment choice should be according to patients condition.