经皮骶正中入路骶骨成形术治疗多节段骶骨体转移瘤

Percutaneous sacroplasty via interpedicular approach for painful sacral metastases involving multiple sacral vertebral bodies

目的探讨经皮骶正中入路骶骨成形术治疗多节段骶骨体转移瘤的初步临床价值。方法回顾性分析2017年3月到2018年9月收治11例经皮骶正中入路骶骨成形术治疗多节段骶骨体转移瘤患者,共实施11个节段22节骶骨体成形术。通过比较患者术前、术后视觉模拟评分(VAS)、止痛药用量和Oswesty功能障碍指数(ODI)评分的变化来评价疼痛、日常运动功能状况的改善情况。结果11例患者手术均获得成功,3例患者发生少量骨水泥外渗,但无严重的临床症状。VAS评分由术前平均(7.09±1.30)分,术后24 h降为(2.82±1.33)分、术后3个月降为(2.64±1.50)分,术后6个月降为(2.45±1.44)(P<0.01)。术前ODI评分平均(74.91±5.47)分,术后24 h、3个月、6个月分别降为(29.27±13.86)分、(28.55±14.31)分和(27.82±14.51)分(P<0.01)。术后4例(36.4%)患者完全不需止痛药,6例(54.6%)止痛药用量减少或止痛药级别降级,1例(9.1%)止痛药维持原剂量。结论经皮骶正中入路骶骨成形术治疗多节段骶骨体转移瘤是一种微创、安全、有效的方法。

Objective To discuss the clinical value of percutaneous sacroplasty(PSP)via sacral interpedicular approach in treating sacral metastases involving multiple sacral vertebral bodies.Methods The clinical data of 11 consecutive patients with sacral metastases involving multiple sacral vertebral bodies,who were admitted to authors’hospital during the period from March 2017 to September 2018 to receive PSP via sacral interpedicular approach,were retrospectively analyzed.A total of 11 segmental sacral osteoplasty procedures,containing 22 diseased sacral bodies in total,were accomplished.The preoperative and postoperative visual analogue scale(VAS)score,used dose of analgesics and Oswesty dysfunction index(ODI)were used to evaluate the improvement of pain and daily activity status.Results Successful PSP was achieved in all 11 patients.A small amount of bone cement extravasation was observed in 3 patients,but no severe clinical symptoms occurred.The mean VAS score decreased from preoperative(7.09±1.30)points to 24-hour postoperative(2.82±1.33)points,further to 3-month postoperative(2.64±1.50)points and to 6-month postoperative(2.45±1.44)points(P<0.01).The mean ODI score decreased from preoperative(74.91±5.47)points to(29.27±13.86)points,(28.55±14.31)points and(27.82±14.51)points at 24 hours,3 months and 6 months after PSP respectively(P<0.01).A fter PSP,4 patients(36.36%)did not need to take analgesics any more,in 6 patients(54.55%)the dosage of analgesics was reduced or the grade of analgesics was lowered,and only in one patient(9.09%)the same dosage of analgesics as preoperative one had to be kept.Conclusion For the treatment of painful sacral metastases involving multiple sacral vertebral bodies,PSP via sacral interpedicularl approach is minimally-invasive,safe and effective.