经皮椎体成形术结合骨填充网袋治疗胸椎转移瘤的临床应用

Use of percutaneous vertebroplasty combined with bone-filling mesh container in the treatment of thoracic spine metastases

目的:观察经皮椎体成形术(PVP)结合骨填充网袋治疗胸椎转移瘤的临床疗效。方法:回顾性分析本院2017年6月至2019年6月病例,其中8例共8椎行PVP术结合骨填充网袋;10例共13椎单纯行PVP术。比较两组术前及术后1 d、1 w患者VAS评分,及观察骨水泥在椎体内的分布情况。结果:骨填充网袋组术前、术后1 d、1 w VAS评分分别为8.91±0.44、3.16±1.03、2.62±0.75;单纯PVP组术前、术后1 d、1 w VAS评分分别为9.23±0.36、3.55±0.72、2.78±0.68。两组术后VAS评分均较术前明显改善(P<0.05),两组之间差异无统计学意义(P>0.05)。骨填充网袋组轻度椎旁及椎间盘骨水泥渗漏3椎,椎旁静脉丛骨水泥渗漏1椎;单纯PVP组椎旁及椎间盘骨水泥渗漏6椎,椎旁静脉丛骨水泥渗漏3椎,后壁骨水泥渗漏1椎。两组均未发现任何骨水泥渗漏引起的相关并发症。结论:PVP能有效缓解胸椎体转移瘤引起的疼痛,结合骨填充网袋能有效减少骨水泥渗漏,是治疗骨壁破坏性胸椎转移瘤的有效方法。

Objective:To investigate the clinical efficacy of percutaneous vertebroplasty(PVP)combined with bone-filling mesh container(BFMC)in the treatment of thoracic spine metastases.Methods:This was a retrospective analysis on patients with thoracic spine metastases treated in our hospital between June 2017 and June 2019,comprising eight(eight vertebrae)receiving PVP combined with BFMC,and 10(13 vertebrae)receiving PVP alone.The VAS scores in the patients prior to and at one day,one week after surgery,as well as intravertebral distribution of bone cement,were compared between the two groups.Results:The VAS scores prior to and at one day,one week after surgery in patients receiving PVP and BFMC were 8.91±0.44,3.16±1.03,and 2.62±0.75,compared with 9.23±0.36,3.55±0.72,and 2.78±0.68 in patients receiving PVP alone,respectively.The postoperative VAS scores in the two groups were significantly improved compared with baseline(P<0.05),with no statistically significant difference between the two groups(P>0.05).Of vertebrae treated with PVP and BFMC,cement leakages to paravertebral space and intervertebral disc(mild,n=3)and paravertebral vein plexus(n=1)were noted;of vertebrae treated with PVP alone,cement leakages to paravertebral space and intervertebral disc(n=6),paravertebral vein plexus(n=3)and and the posterior wall of vertebral body(n=1).In either group,there were no complications related to the bone cement leakage.Conclusion:PVP can effectively relieve the pain caused by thoracic spine metastases.PVP combined with bone-filling mesh container can effectively reduce bone cement leakage,and is useful for treatment of bone-destructive thoracic spine metastases.