经皮椎体成形术与开放性椎体成形术治疗脊柱转移瘤

Percutaneous vertebroplasty and open vertebroplasty for metastatic spinal tumor

目的:探讨经皮椎体成形术与开放性椎体成形术在脊柱转移瘤治疗中的临床应用。方法 :对2012年1月至2016年3月行手术并获得随访的126例脊柱转移性肿瘤患者进行回顾性分析,126例患者依据手术方式不同分为两组,转移性肿瘤进入椎管压迫脊髓、神经根的患者,行开放性手术治疗(开放手术组,43例);无明显脊髓或神经根受压,或不适宜开放手术者行经皮椎体成形术治疗(PVP组,83例)。采用VAS评分、ECOG分级、Frankel分级分别对患者的疼痛、功能状况和脊髓功能进行评价;出院后每3个月门诊随访1次,行X线、CT或MRI检查,每次随访均进行疼痛、神经功能和活动能力的评估。结果:PVP组治疗112个椎体,基本无出血,中位手术时间50 min;术后2 d时VAS评分即有显著降低,并持续至术后1个月;ECOG分级在术后1个月时有显著降低;除了无症状的骨水泥渗漏(44/112)外,未发生神经损伤或肺栓塞等严重并发症;中位生存时间为16个月。开放手术组中位手术时间160 min,中位出血量1 000 ml;术后1个月时VAS评分显著降低;ECOG分级在术后1个月有显著降低;术前41例有脊髓功能障碍患者中有36例术后Frankel分级得到提高(87.8%);40例运动功能不完全丧失患者中有29例完全恢复(76.3%)。术后12例出现并发症(27.9%),中位生存时间为11个月。结论 :对脊柱转移瘤患者选择合适方式的椎体成形术可以有效重建脊柱稳定性,减轻疼痛,提高患者的生活质量。

Objective： To explore the clinical application and therapeutic effect of percutaneous vertebroplasty（PVP） and open vertebroplasty for metastatic spinal tumor.Methods： The clinical data of 126 patients with metastatic spinal tumor underwent surgery and obtained follow-up from January 2012 to March 2016 were retrospectively analyzed. These 126 cases were divided into two groups according to different operative methods. The metastatic tumor of 43 cases encroached vertebral canal oppressing spinal cord and nerve root,they were treated with open operation（open vertebroplasty group）;and other 83 cases without obviously spinal cord or nerve root compression,or unfit for open operation,were treated with PVP （percutaneous vertebroplasty group）. VAS score,ECOG and Frankel grade were used to evaluate the pain and neurofunction in two groups.All out-hospital patients were followed up every 3 months for 1 time. X-ray,CT,MRI were examined in follow-up.Results： A total of 112 vertebrae underwent PVP with the median surgical time of 50 min;VAS scores decreased significantly at 2 days after operation,which maintained till 1 month later;ECOG grade at 1 month decreased significantly;44 of 112 vertebrae suffered from asymptomatic bone cement leakage,no complications such as nerve injury or pulmonary embolism was found;the median survival time was 16 months. While for open vertebroplasty group,the median surgical time was 160 min and blood loss was 1 000 ml;postoperative VAS scores and ECOG grade at 1 month decreased significantly. Postoperative Frankel grade of 36 patients got improvement in 41 patients with spinal cord functional disturbance（87.8%）;and 29 of 40 patients with incompleteness out of motor function were full recovery（76.3%）;12 cases （27.9%） occurred complications and the median survival time was 11 months.Conclusion： The different vertebroplasty treatments can be selected for patients with metastatic spinal tumor,which can relieve the pain,improve the nerve function,reconstruct the spinal stabilization,maintain the local control and raise the life quality.