经皮椎体后凸成形术治疗成骨性胸腰椎转移癌的临床疗效

Clinical evaluation of percutaneous kyphoplasty for the treatment of osteoblastic thoracic and lumbar metastatic lesions

目的：探讨经皮椎体后凸成形术（PKP）治疗成骨性胸腰椎转移癌的临床疗效。方法回顾性分析苏州大学附属第一医院骨科2009年9月—2015年1月采用 PKP 治疗成骨性椎体转移癌14例患者的临床资料,其中男9例、女5例,年龄48-74岁,共累及19节椎体（9节胸椎和10节腰椎）,原发灶为乳腺癌5例、肺癌4例、前列腺癌4例、胃癌1例。在术前及术后第3天、1个月、3个月和末次随访时,应用视觉模拟评分法（VAS）和 Oswestry 功能障碍指数（ODI）,评价患者疼痛及功能恢复情况,采用 SPSS 13.0统计软件进行统计学分析。结果所有患者顺利完成手术,术后获得随访3个月-4年,平均（22±13）个月,所有患者主诉术后胸背部疼痛症状获得不同程度的改善。术前VAS 评分为（8.4±0.5）分,术后随访 VAS 评分呈现不同程度下降,分别为术后第3天（2.4±0.8）分,术后1个月（1.7±0.6）分,术后3个月（1.5±0.5）分,末次随访（1.4±0.6）分。术前 ODI 为75.0±10.7,术后第3天34.6±10.9,术后1个月25.9±8.5,术后3个月25.6±7.8,末次随访27.5±9.3。术后不同时间点的 VAS 评分和 ODI 相比术前,差异均有统计学意义（P 值均〈0.01）。所有患者无术中骨水泥渗漏、术后邻近椎体骨折和椎体骨折骨不连等并发症发生。结论 PKP 可以明显缓解成骨性椎体转移癌患者的疼痛症状和提高生活质量,是一种安全、有效的微创外科手术技术。

Objective To evaluate the therapeutic efficacy of percutaneous kyphoplasty（PKP） in the treatment of osteoblastic thoracic and lumbar metastatic lesions. Methods Fourteen patients with osteoblastic thoracic or/ and lumbar metastases were treated by PKP in Department of Orthopaedic Surgery, the First Affiliated Hospital of Soochow University from Sep. 2009 to Jan. 2015. The clinical data were retrospectively analyzed. Nine thoracic vertebraes and 10 lumbar vertebraes in 14 patients （9 males and 5 females）, whose average age was（63 ± 8. 9） years old（range from 48 to 74 years old）, were performed with PKP, involving the primary tumor of breast cancer （n = 5）, lung cancer （n = 4）, prostate cancer （n = 4） and stomach cancer （ n = 1）. Visual analogue scale （ VAS） and Oswestry disabilily index （ ODI） were statistically analyzed to evaluate pain remission and functional recovery of patients at preoperative and at pre-and post-operative 3 days, 1 month, 3 months and the last follow-up with SPSS 13. 0 software. Results All patients who were followed up for （22 ± 13） months （ range 3 months to 4 years）, received back pain improvement postoperatively. The mean VAS dropped from preoperative （8. 4 ± 0. 5） to （2. 4 ± 0. 8）, （1. 7 ± 0. 6）, （1. 5 ± 0. 5）, （1. 4 ± 0. 6） at 3 days, 1 month, 3 months and the last follow-up after the treatment, respectively. The mean ODI decreased from preoperative （75. 0 ± 10. 7） to （34. 6 ± 10. 9）, （25. 9 ± 8. 5）, （25. 6 ± 7. 8）, （27. 5 ± 9. 3） at 3 days, 1 month, 3 months and the last follow-up after the treatment, respectively. The pre- and post-operative data of VAS and ODI scores showed statistic differences （all P values 〈 0. 01）. Conclusions PKP has satisfactory efficacy in pain relief and function improvement for patients with osteoblastic thoracic and lumbar metastatic lesions, which is a feasible and effective minimally invasive procedure.