DSA引导下射频消融术联合PVP治疗脊柱转移瘤:骨水泥渗漏及预后生存情况分析

DSA-guided radiofrequency ablation combined with PVP for spinal metastases: analysis of cement leakage and prognostic survival

目的探讨DSA引导下射频消融(radio frequency ablation,RFA)联合经皮椎体成形术(Percutaneous vertebroplasty,PVP)治疗脊柱转移瘤的临床效果。方法选取2012年1月-2016年6月本院收治的脊柱转移瘤患者50例,按随机数字表法分为对照组(n=25)和观察组(n=25)。对照组给予PVP技术治疗,观察组行DSA引导下RFA联合PVP技术治疗。对两组患者的手术并发症和预后情况进行比较。结果与术前比较,术后7 d、3个月、6个月两组患者ODI、VAS评分均显著降低,且观察组显著低于对照组(P<0.01);术后观察组与对照组的临床总有效率分别为92.00%、68.00%,观察组显著高于对照组(P<0.05);与术前比,术后两组骨代谢生化指标NTx、ICTP、BAP水平均显著降低,且观察组显著低于对照组(P<0.01);术后6个月观察组与对照组患者肿瘤复发率分别为8.00%、32.00%,观察组显著低于对照组(P<0.05);术后观察组与对照组患者骨水泥外渗率分别为12.00%、44.00%,观察组显著低于对照组(P<0.05);术后随访2-3年,观察组生存期显著高于对照组(P<0.01)。结论RFA联合PVP技术可有效缓解脊柱转移瘤患者的临床症状,降低NTx、ICTP、BAP水平,减少骨水泥外渗情况的发生,降低肿瘤复发率,提高患者临床总有效率,提高脊柱转移瘤患者的生存期,且疗效优于单纯使用PVP技术,值得推广应用。

Objective To explore the clinical effect of radiofrequency ablation(RFA)combined with percutaneous vertebroplasty(PVP)in the treatment of spinal metastases,and to analyze its impact on the prognosis of patients.Methods A prospective study was conducted in 50 patients with spinal metastases admitted to our hospital from January 2012 to June 2016.They were divided into the control group(n=25)and the observation group(n=25)according to random number table method.The control group was treated with PVP,and the observation group was treated with RFA on this basis.The operative complications and prognosis of the two groups were compared.Results Compared with before operation,the ODI and VAS scores of the two groups decreased significantly at 7 days,3 months and 6 months after operation,and those of the observation group were lower than the control group(P<0.01).The total effective rates of the observation group and the control group were 92.00%and 68.00%respectively,and the effective rate of the observation group was significantly higher than the control group(P<0.05).Compared with before operation,the levels of NTx,ICTP and BAP of bone metabolism in the two groups were significantly lower after operation,and those of the observation group were lower than the control group(P<0.01).The recurrence rate of tumors in the observation group was 8.00%at 6 months after operation,which was significantly lower than 32.00%in the control group(P<0.05).The exosmosis rate of bone cement in the observation group was 12.00%,which was significantly lower than 44.00%in the control group(P<0.05).After 2-3 years of follow-up,the survival time of the observation group was significantly longer than that of the control group(P<0.01).Conclusion RFA combined with PVP can effectively alleviate the clinical symptoms of spinal metastases,reduce the levels of NTx,ICTP and BAP,reduce the occurrence of extravasation of bone cement,reduce the recurrence rate of tumors and improve the total clinical efficacy of patients,improve the survival of patients with spinal metastases,and the curative effect is better than PVP alone,which is worthy of clinical application.