RFA辅助椎体次全切除术治疗脊柱转移瘤手术效果及预后研究

Surgical outcome and quality of prognosis of RFA assisted subtotal corpectomy in the treatment of spinal metastases

目的研究经皮穿刺射频消融(RFA)辅助椎体次全切除术对脊柱转移瘤患者的临床疗效。方法选取该院2014年10月到2016年10月间收治的脊柱转移瘤患者84例,采用随机数字表法将其分为对照组和观察组,每组42例。对照组患者接受单纯椎体次全切除术治疗,观察组患者辅以RFA治疗。比较两组患者的手术时间、术中出血量、住院时间、并发症发生率、复发率及病死率,术后随访,比较两组患者手术前后各时间点的视觉模拟法(VAS)评分、脊髓损伤(Frankel)分级和美国东部肿瘤协作组(ECOG)分级。结果观察组的手术时间、术中出血量及住院时间均明显低于对照组(P<0.01),观察组的总渗漏率明显低于对照组(χ2=6.10,P=0.01);术后1、3个月,观察组的VAS评分明显低于对照组(P<0.01);术后6个月,观察组和对照组患者的Frankel和ECOG分级均平均改善1级,组间比较差异无统计学意义(P>0.05);术后1年,观察组的复发率明显低于对照组(χ2=11.83,P=0.00)。结论 RFA辅助椎体次全切除术治疗脊柱转移瘤,可减少手术时间及出血量,缓解患者疼痛感,且术后并发症发生率低,值得在临床推广。

Objective To study the clinical efficacy of percutaneous radiofrequency ablation(RFA)assisted subtotal corpectomy in patients with spinal metastases.Methods Eighty-four patients with spinal metastases admitted to this hospital from October 2014 to October 2016 were randomly divided into the control group and the observation group,with 42 cases in each group.Patients in the control group underwent subtotal corpectomy,and patients in the observation group were treated with RFA assisted.The operation time,intraoperative blood loss,hospitalization time,complication rate,recurrence rate and mortality were compared between the two groups.The VAS score,Frankel grade and ECOG grade were compared between the two groups before and after operation.Results The operation time,intraoperative blood loss and hospitalization time of the observation group were significantly lower than those of the control group(P<0.01).The total leakage rate of the observation group was significantly lower than that of the control group(χ2=6.10,P=0.01);1 month,3 months after surgery,the VAS score in the observation group was significantly lower than that in the control group(P<0.01),at the time of 6 months after surgery,the Frankel and ECOG grades of the patients in the observation group and the control group were improved by an average of 1 grade,and there was no significant difference between the two groups(P>0.05);1 years after the surgery,the recurrence rate of the observation group was significantly lower than that of the control group(χ2=11.83,P=0.00).Conclusion RFA assisted corpectomy in the treatment of spinal metastases can reduce the operation time and blood loss,relieve the pain,and the incidence of postoperative complications is low,which is worthy of clinical promotion.