经皮椎体成形术联合肿瘤介入摘除术治疗转移瘤导致的椎体压缩性骨折

Percutaneous vertebroplasty combined with interventional tumor removal in treatment of vertebral compression fracture caused by metastatic tumor

目的探究经皮椎体成形术(PVP)联合肿瘤介入摘除术(ITR)治疗转移瘤导致的椎体压缩性骨折的疗效,并评价其安全性。方法2014年1月—2017年6月收治中国人民解放军陆军第八十三集团军医院转移瘤导致的椎体压缩性骨折患者共94例,其中49例采用PVP治疗(PVP组),45例采用PVP联合ITR治疗(PVP+ITR组)。记录2组患者的骨水泥注射量及骨水泥渗漏情况,观察神经功能障碍及感染等并发症发生情况,采用疼痛视觉模拟量表(VAS)评分评价疼痛改善情况。结果所有手术顺利完成,所有患者随访超过12个月。PVP组骨水泥注射量为(3.12±0.67)mL,PVP+ITR组为(5.33±1.67)mL,差异有统计学意义(P<0.05)。PVP组骨水泥渗漏率为48.98%,PVP+ITR组为20.75%,差异有统计学意义(P<0.05)。2组患者术后VAS评分均较术前改善,且术后1、3、6、12个月PVP+ITR组VAS评分优于PVP组,差异均有统计学意义(P<0.05)。2组患者术后均未见神经功能障碍及感染等并发症发生。结论PVP联合ITR治疗转移瘤导致的椎体压缩性骨折能够有效维持椎体稳定,减少骨水泥渗漏的发生,有效缓解疼痛,具有临床应用价值。

Objective To explore the effect and safety of percutaneous vertebroplasty(PVP)combined with interventional tumor removal(ITR)on the treatment of vertebral compression fracture caused by metastatic tumor.Methods From January 2014 to June 2017,94 patients with vertebral compression fracture caused by metastatic tumor at Army 83rd Group Military Hospital of Chinese PLA were selected,of whom 49 were treated with PVP(PVP group)and 45 were treated with PVP combined with ITR(PVP+ITR group).The injection amount of bone cement and leakage of bone cement were recorded.The occurrence of complications such as neurological dysfunction and infection were observed.The improvement of pain was evaluated by pain visual analogue scale(VAS)score.Results All the operations were successfully completed.All the patients were followed up for more than 12 months.The injection amount of bone cement was(3.12±0.67)mL in PVP group and(5.33±1.67)mL in PVP+ITR group,and the difference was statistically significant(P<0.05).The leakage rate of bone cement was 48.98%in PVP group and 20.75%in PVP+ITR group,and the difference was statistically significant(P<0.05).The VAS score of PVP+ITR group was better than that of PVP group at 1,3,6,12 months postoperatively,and differences were all statistically significant(P<0.05).No complications such as neurological dysfunction and infection were found in the 2 groups.Conclusion PVP combined with ITR in the treatment of vertebral compression fracture caused by metastatic tumor can effectively maintain the stability of the vertebral body,prevent bone cement leakage,and releve the pain,being of clinical application value.