多节段经皮椎体成形术治疗溶骨性椎体转移瘤的疗效及安全性评价

Efficacy and safety of multi-segment percutaneous vertebroplasty in the treatment of osteolytic vertebral metastases

目的观察和评估多节段经皮椎体成形术(PVP)治疗溶骨性椎体转移瘤的疗效及安全性。方法回顾性选取2014年1月至2017年1月首都医科大学附属北京友谊医院收治的多节段PVP治疗椎体转移瘤的72例患者。收集患者的病例资料,分别记录患者术前24 h、术后3 d、术后1个月的视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)评分。使用配对t检验分析术前和术后VAS和ODI差异,评估疗效。通过术后复查CT,观察骨水泥渗漏情况,记录术中及术后并发症进行安全性评价。结果本研究共纳入72例多节段PVP的椎体转移瘤患者,其中男性36例,女性36例;年龄为32~87岁,平均(61.28±1.53)岁。行2个节段PVP治疗的患者30例(41.67%),3个节段8例(11.11%),4个节段9例(12.5%),5个节段12例(16.67%),6个节段7例(9.72%),7个节段2例(2.78%),8个节段4例(5.56%)。原发肿瘤中最多见的3个原发肿瘤部位是肺癌(41.67%)、乳腺癌(16.67%)、肾癌(8.33%)。所有患者均顺利完成手术,术后疼痛明显缓解。VAS评分从术前的(7.39±0.10)分降至术后3 d的(4.40±0.12)分(P<0.05)、术后1个月的(3.82±0.13)分(P<0.05);ODI评分从术前的(74.30±1.02)%降至术后3 d的(45.46±1.19)%(P<0.05)、术后1个月的(37.82±0.93)%(P<0.05)。共268个节段行PVP,术后CT证实40个椎体无症状性骨水泥渗漏,渗漏率为14.9%。结论多节段经皮椎体成形术治疗溶骨性椎体转移瘤的是一种安全有效的技术,其可用作对镇痛药耐药的首选治疗方法。

Objective To observe and evaluate the efficacy and safety of multi-segment percutaneous vertebroplasty(PVP)in the treatment of osteolytic vertebral metastases.Methods A retrospective study of 72 patients with vertebral metastases treated with multi-segment PVP in Beijing Friendship Hospital,Capital Medical University from January 2014 to January 2017 was performed.The patients’medical records were collected.The visual analogue scale(VAS)and Oswestry dysfunction index(ODI)scores were recorded 24 hours before surgery,3 days after surgery,and 1 month after surgery.The paired t-test was used to analyze the difference between preoperative and postoperative VAS and ODI to evaluate the efficacy.Postoperative CT examination was conducted to observe the bone cement leakage.The complications of intraoperative and postoperative was recorded to evaluate safety of PVP.Results A total of 72 patients with multi-segment PVP vertebral metastases were enrolled in the study.There were 36 males and 36 females,aged 32-87 years,with an average age of(61.28±1.53)years.30 patients(41.67%)underwent PVP treatment in two segments,eight patients(11.11%)in three segments,nine patients(12.5%)in four segments,and 12 patients(16.67%)in five segments,six patients(9.72%)in seven segments,two patients(2.78%)in seven segments,and four patients(5.56%)in eight segments.The three most common primary tumor sites were lung cancer(41.67%),breast cancer(16.67%),and kidney cancer(8.33%).All patients successfully completed the operation,and their pain was significantly relieved.VAS decreased from preoperative 7.39±0.10 to 4.40±0.12 after 3 days(P<0.05),and to 3.82±0.13 after one month(P<0.05).ODI score decreased from preoperative(74.30±1.02)%to(45.46±1.19)%after 3 days(P<0.05),and to(37.82±0.93)%after 1 month(P<0.05).Postoperative CT confirmed 40 vertebral asymptomatic cement leakage with the rate of 14.9%.Conclusion Multi-segment PVP injection is a safe and effective technique for multi-segment osteolytic vertebral metastases,which can be used as the first choice for patients with painkillers resistance.