后路减压内固定术结合术中^(125)I粒子永久性植入治疗脊柱转移瘤脊髓压迫症

Surgical decompression and spine stabilization combined with permanent ^(125)I seed implantation in treatment of metastatic epidural spinal cord compression

目的观察后路减压内固定术结合术中^(125)I粒子永久性植入治疗脊柱转移瘤脊髓压迫症(MESCC)的疗效。方法回顾性分析2012年1月—2014年12月在本院行后路减压内固定术结合术中^(125)I粒子植入(研究组,n=20)或术后常规放疗(对照组,n=40)的MESCC病例,观察并比较两组患者术后疼痛视觉模拟量表(VAS)评分、卡氏功能状态量表(KPS)评分、神经功能预后、生存期和并发症发生率。结果两组患者术后VAS评分均低于术前(P<0.05),KPS评分均高于术前(P<0.05)。研究组术后1周、1个月和3个月VAS评分明显低于对照组(P<0.05),术后6个月两组VAS评分相近。研究组术后1周和1个月KPS评分明显高于对照组(P<0.05),术后3个月、6个月两组KPS评分相近。研究组和对照组术后分别有90.0%(18/20)和75.0%(30/40)的患者具备行走能力,中位生存期分别为7.0个月(95%可信区间:4.3~13.7个月)和6.6个月(95%可信区间:3.8~9.0个月),并发症发生率分别为10.0%(2/20)和15.0%(6/40),两组差异均无统计学意义(P>0.05)。结论后路减压内固定术结合术中125I粒子植入治疗MESCC在短期疼痛缓解和一般体力状态改善方面,疗效优于后路减压内固定术联合术后常规放疗。

Objective To investigate the efficacy of surgical decompression and spine stabilization combined with permanent ^(125)I brachytherapy seed implantation in the treatment of metastatic epidural spinal cord compression(MESCC). Methods MESCC patients treated with surgical decompression and spine stabilization combined with permanent ^(125)I brachytherapy seed implantation(study group,n=20) or surgical decompression and spine stabilization followed by radiotherapy(control group,n=40) were retrospectively analyzed between January 2012 and November 2014. Visual analogue scale(VAS) score,Karnofsky performance scale(KPS) score,neurological outcome,survival prognosis,and rates of complications were compared between the 2 groups. Results Postoperative VAS scores were significantly lower than preoperative those,and postoperative KPS scores were significantly higher than preoperative those in both groups(P < 0.05). The VAS scores in the study group were significantly lower than the those in the control group at 1 week,1 months,and 3 months after surgery(P < 0.05),and similar in both groups at postoperative 6 months. The KPS scores in the study group were significantly higher than those in the control group at 1 week,and 1 months after surgery(P < 0.05),and similar in both groups at postoperative 3 and 6 months. There were 18(90.0%) and 30(75.0%) patients having the ability to walk after surgery in the study and control group,respectively,with no significant difference. The median survival time was 7.0 months(95% confidence interval :4.3-13.7 months) and 6.6 months(95% confidence interval :3.8-9.0 months) in the study and control group,respectively,with no significant difference(P < 0.05). Complication occurred in 2(10.0%) patients in the study group and 15.0%(6/40) in the control group,with no significant difference(P > 0.05). Conclusion Surgical decompression and spine stabilization combined with permanent 125 I brachytherapy seed implantation is superior to the treatment with decompressive surgery followed by radiotherapy in MESCC patients in terms of short term pain relief and improvement of performance status.