经皮椎体成形联合125I粒子植入术治疗胸椎转移瘤合并椎体后缘缺损患者的疗效和安全性

Clinical study of percutaneous vertebroplasty combined with 125I seeds implantation in the treatment of patients with thoracic metastatic tumor complicated with posterior vertebral defect

目的分析经皮椎体成形联合125I粒子植入术(PVPI)治疗胸椎转移瘤合并椎体后缘缺损患者的安全性和有效性。方法回顾性分析2017年11月至2019年5月云南省肿瘤医院收治的64例胸椎转移瘤患者的临床资料,其中椎体后缘缺损者(研究组)32例,无椎体后缘缺损者(对照组)32例。对PVPI手术关键技术进行改良,采用二次封堵法和斜面穿刺针推注骨水泥旋转填充技术减少渗漏,治疗研究组32例患者的42节椎体。32例对照组患者的54节椎体行PVPI手术。分别于术后第2天、1个月、3个月和6个月对两组患者进行随访,比较两组患者的近期疗效、远期疗效和安全性等指标。结果64例患者均顺利完成手术治疗,研究组和对照组患者的视觉模拟评分、卡氏功能状态评分在术后第2天、1个月、3个月和6个月均较术前得到不同程度地改善,两组差异均无统计学意义(均P>0.05)。研究组和对照组患者的骨水泥量分别为(2.36±0.20)ml和(2.39±0.17)ml,差异无统计学意义(P=0.482);125I粒子植入量分别为(30.63±0.91)个和(32.56±0.68)个,差异无统计学意义(P=0.925)。研究组和对照组患者的部分缓解率分别为81.3%和87.5%,疾病稳定率分别为12.5%和9.4%,差异无统计学意义((均P>0.05)。研究组患者的中位总生存时间(OS)为13.0个月,中位无进展生存时间(PFS)为8.0个月;对照组患者的中位OS为14.0个月,中位PFS为8.0个月,差异均无统计学意义(均P>0.05)。研究组患者共有6节(14.3%)椎体出现骨水泥渗漏,其中2节(4.8%)为椎管内渗漏,4节(9.5%)为椎旁骨水泥渗漏。对照组患者共出现7节(13.0%)椎旁骨水泥渗漏。两组患者骨水泥渗漏情况的差异无统计学意义(P=0.097)。两组患者的骨水泥渗漏均未造成脊髓损伤等严重并发症。结论应用PVPI治疗椎体后缘缺损的胸椎转移瘤患者,只要进行术中技术改良,注意控制骨水泥分布等问题,仍能获得较好的临床疗效和安全性。

Objective To analyze the safety and efficacy of percutaneous vertebroplasty combined with interstitial implantation 125I of seeds(PVPI)in the treatment of thoracic vertebroplasty with posterior vertebra defect.Methods A retrospective analysis of the clinical data of 64 patients with thoracic spine metastases admitted to Yunnan Cancer Hospital from November 2017 to May 2019 was conducted,including 32 patients with posterior vertebra defect(experimental group)and 32 cases without(control group).Forty-two vertebral bodies of 32 patients in the experimental group were treated with improved PVPI surgery,which performed with the secondary sealing method and inclined puncture needle injection bone cement rotary filling technology,to reduce leakage.The 54 vertebral bodies of 32 patients in control group underwent PVPI.The two groups of patients were followed up on the second day,one month,three months and six months after the operation,and the short-term efficacy,long-term efficacy and safety indicators of the two groups were compared.Results All 64 patients successfully completed the surgical treatment.The visual analogue scores and Karnofsky scores of the experimental group and the control group were improved to varying degrees on the second day,1 month,3 months and 6 months after the operation.There was no statistically significant difference between the two groups(P>0.05).The amount of bone cement in the experimental group and control group was(2.36±0.20)ml and(2.39±0.17)ml,and the difference was not statistically significant(P=0.482).The amount of 125I seed implantation was(30.63±0.91)and(32.56±0.68),respectively,the difference was not statistically significant(P=0.925).The partial response rates of the study group and the control group were 81.3%and 87.5%,the stable disease rates were 12.5%and 9.4%,the differences were not statistically significant(P>0.05).The median overall survival(mOS)of the study group was 13 months,and the median progression-free survival(mPFS)was 8 months.The mOS of the control group was 14 months,and the mPFS was 8 months.The differences were not statistically significant(P>0.05).In the experimental group,6(14.3%)vertebral bodies had cement leakage,of which 2(4.8%)were cement leakage at posterior vertebra,4(9.5%)were paravertebral cement leakage.Seven(13.0%)paravertebral cement leakage occurred in the control group.There was no significant difference in bone cement leakage between the two groups(P=0.097).Bone cement leakage in both groups did not cause serious complications such as spinal cord injury and paraplegia.Conclusion The application of PVPI in the treatment of thoracic metastatic tumor patients with posterior vertebra defect can acquire better clinical efficacy and safety through conduction of the improved intraoperative technology and paying more attention to the control of bone cement distribution and other issues.