射频消融联合经皮椎体后凸成形术治疗脊柱转移癌的临床初步研究

The preliminary study on image-guided radiofrequency ablation combined with percutaneous kyphoplasty to spinal metastases

目的初步探讨射频消融(radiofrequency ablation,RFA)联合经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗脊柱转移癌的临床疗效。方法对2013年9月至2015年9月于广元市中心医院骨科行RFA联合PKP治疗脊柱转移癌的18例(24椎)病人的临床资料进行回顾性分析,比较其术前、术后1 d、1周及1、2、3、6个月的疼痛视觉模拟量表(visual analogue scales,VAS)评分、日本骨科协会(Japanese Orthopaedic Association,JOA)评估治疗分数、罗兰-莫里斯生活障碍问卷(Rolando-Morris disability questionnaire,RMDQ)评分,同时通过术后随访复查的X线片,测量椎体前缘高度,记录骨水泥渗漏情况。结果全部病人术后24 h内疼痛明显缓解,技术成功率为100%,均得到3个月以上随访,平均随访时间为5.2个月。术后3个月,9例(50.0%)疼痛完全缓解,7例(38.9%)止痛药用量减少或止痛药级别降低,2例(11.1%)止痛药维持原量。治疗后(术后1 d、1周及1、2、3、6个月)的VAS、JOA、RMDQ评分及椎体前缘高度均较治疗前显著改善,差异均有统计学意义(P均<0.05)。结论 RFA联合PKP可明显提高病人生活质量,手术方式安全,对脊柱转移癌病人微创、有效。

Objective To explore the clinical curative effect and safety of radiofrequency ablation(RFA) combined with percutaneous kyphoplasty(PKP) to the spinal metastases.Methods The clinical data of18 patients(24 vertebral bodies) with RFA combined with PKP in the treatment of spinal metastases fromSeptember 2013 to September 2015 were analyzed retrospectively.The visual analogue scales(VAS) scores,Japanese Orthopaedic Association(JOA) scores,Rolando-Morris disability questionnaire(RMDQ) and theanteriorvertebral body height changes were evaluated at the 1st day,1st week and the 1st,2nd,3rd and 6thmonth postoperatively.Results All patients were significantly relieved within 24 h after operation.Thetechnical success rate was 100%.All patients were followed up for more than 3 months,with an average follow-up time of 5.2 months.Nine cases(50.0%) got the pain relief completely at the 3rd month postoperation.Medication requirements decreased or dosage of analgesic was reduced in 7 cases(38.9%),and the dosage ofanalgesic maintained unchanged in 2 cases(11.1%).The VAS,JOA,RMDQ scores and the anterior height ofvertebral body were significantly improved at 1st day,1st week and 1st,2nd,3rd and 6th month after treatment,and the differences were statistically significant(P<0.05 for all).Conclusion RFA combined with PKP withminimal injury could improve the quality of patients life significantly,and safe and feasible for patients withspinal metastases.