射频消融术联合经皮椎体后凸成形术对脊柱转移性肿瘤患者疼痛及疗效的影响研究

Effect of RFA combined with PKP on pain relief and the clinical efficacy in patients with metastatic spinal tumor

目的探讨经皮椎体后凸成形术(PKP)联合射频消融术(RFA)对脊柱转移性肿瘤患者疼痛及疗效的影响。方法回顾性分析227例(共405节椎体)脊柱转移性肿瘤患者的病历资料,其中联合组(采用PKP联合RFA治疗)患者164例,245节椎体,PKP组(单独采用PKP治疗)患者63例,160节椎体。比较两组患者疼痛缓解情况、Oswestry功能障碍指数、视觉模拟评分及影像学改变情况。结果两组患者术前视觉模拟评分比较,差异无统计学意义(P﹥0.05);术后1天、术后5个月,联合组患者视觉模拟评分均低于PKP组,差异均有统计学意义(P﹤0.05)。术后1周、术后2个月,联合组患者疼痛缓解有效率均高于PKP组,差异均有统计学意义(P﹤0.05);术后5个月,联合组患者疼痛缓解有效率明显高于PKP组,差异有统计学意义(P﹤0.01)。两组患者术前Oswes-try功能障碍指数比较,差异无统计学意义(P﹥0.05);术后3天、1周、2个月、5个月,联合组患者Oswestry功能障碍指数均明显低于PKP组,差异均有统计学意义(P﹤0.01)。术前两组患者椎体前缘、椎体中部高度比较,差异均无统计学意义(P﹥0.05);术后,联合组患者椎体前缘、椎体中部高度均明显高于PKP组,差异均有统计学意义(P﹤0.01)。结论 PKP联合RFA治疗脊柱转移性肿瘤可缓解患者疼痛,改善患者日常活动功能,更好地提高病变椎体高度,增强脊柱的稳定性,效果显著。

Objective The study aims to evaluate the effect of percutaneous kyphoplasty(PKP)combined with radiofrequency ablation(RFA)for relieving pain and the clinical efficacy in patients with metastatic spinal tumor.Method A retrospective analysis which included 227 cases of metastatic spinal tumor(405 vertebral bodies)was performed,in which the combined therapy group(treated by PKP combined with RFA)contained 164 cases(245 vertebral bodies),and PKP group(adopted PKP alone)had 63 cases(160 vertebral bodies).The pain relief,Oswestry disability index(ODI)and visual analogue scale(VAS),as well as the imaging changes were compared.Result There was no significant difference in preoperative VAS between the two groups(P >0.05).In 1 day and 5 months after operation,the VAS in combined therapy group was significantly lower than that in the PKP group,the differences were statistically significant(P<0.05).In 1 week and 2 months after operation,the response rate of pain relief in the combined group was higher than that in the PKP group(P<0.05);and the difference remained significant for 5 months after operation(P<0.01).There was no significant difference in the preoperative ODI between the two groups(P >0.05).While the ODI of the combined therapy group was lower than that of the PKP group in 3 days,1 week,2 months,and 5 months after operation(P<0.01).No significant differences were observed regarding the height of the anterior and middle vertebral bodies between the two groups before surgery(P >0.05);but these were increased significantly in combined therapy group compared with the PKP group,demonstrating statistical difference(P<0.01).Conclusion PKP combined with RFA in the treatment of metastatic spinal tumor significantly relieves pain,improves the daily activity of patients,and may improve the height of affected vertebra,enhancing the stability of the spine,showing remarkable therapeutic effect.