经皮椎体成形术联合内固定治疗多节段脊柱转移癌

Percutaneous Vertebral Plasty Combined with Internal Fixation for Multiple Segmental Metastatic Spine Tumors

目的比较单纯经皮椎体成形术和内固定联合经皮椎体成形术治疗多节段脊柱转移癌的疗效.方法2007年1月至2013年12月,43例多节段脊柱转移癌患者随机分为2组,分别采用经皮椎体成形术及内固定联合经皮椎体成形术治疗.术前2组患者的年龄、性别、体重指数、骨折椎节段和骨密度等指标的差异均无统计学意义.术后1周及末次随访时采用疼痛视觉模拟评分（visual analogue scale,VAS）和Oswestry功能障碍指数Oswestry disability index,ODI）进行疗效评价,摄X线片、CT评估肿瘤复发情况.结果全部病例随访24-59个月,平均34.1个月.术后1周及末次随访时疼痛视觉模拟评分：经皮椎体成形术组分别为（2.9±0.8）、（1.4±1.2）分,经皮内固定联合椎体成形术组分别为（0.9±0.6）、（0.4±0.6）分;Oswestry功能障碍指数：经皮椎体成形术组分别为（29.2±8.1）%、（14.6±8.4）%,内固定联合经皮椎体成形术组分别为（17.9%±4.7）%、（8.1±5.0）%.2组差异均有统计学意义（P〈0.05）.术后X线片、CT提示经皮椎体成形术组肿瘤复发l例,内固定联合经皮椎体成形术组肿瘤复发2例.结论对多节段脊柱转移癌,内固定联合经皮椎体成形术相对于单纯经皮椎体成形术能更加有效地缓解疼痛症状、恢复脊柱稳定,提高生活质量.

Objective To compare the therapeutic effect of Percutaneous vertebral plasty alone and internal fixation combined with Percutaneous vertebral plasty for multiple segmental metastatic spine tumors.Methods From January 2007 to December 2012, 43 patients with Multiple segmental metastatic spine tumors with nerve damage and pain were randomly divided into two groups： Percutaneous vertebral plasty alone group（1） and percutaneous pedicle instrumentation combined with Percutaneous vertebral plasty group（2）.Then Percutaneous vertebral plasty and percutaneous pedicle instrumentation combined with Percutaneous vertebral plasty were performed in patients of each group,respectively.Before operation,there were no statistical differences in many parameters between two groups,such as age,gender,body mass index,affected segments and bone density.X- ray, CT evaluation of tumor recurrence.Results All patients were followed up for 24 to 59 months（average.34.1 months）. after operation,visual analogue scales（VAS）,Oswestry disability index（ODl）were respectively 2.9 ±0.8, 29.2% ±8.1% in group 1, and 0.9 ±0.6, 17.9% ±4.7% in group 2.At final follow- up,VAS score and ODI were respectively 1.4±1.2,14.6%±8.4% in group 1,and 0.4±0.6,8.1%±5.0% in group 2.There were significant differences between two groups at two time points.taken X- ray, CT evaluation with Percutaneous vertebral plasty alone group,vertebral tumor recurrence occurred in 1 patient,and 2patients in group（2）.Conclusion For Multiple segmental metastatic spine tumors,compared with Percutaneous vertebral plasty alone,percutaneous pedicle instrumentation combined with Percutaneous vertebral plasty is more effective in correcting deformity,relieving pain,maintaining vertebral height and restoring spinal stability.