椎体成形术联合消融或^(125)I粒子置入在脊髓压迫症的疗效研究

Comparison of percutaneous vertebroplasty combined with radiofrequency ablation and ^(125)I seed implantation in the treatment of metastatic spinal cord compression

目的对比研究经皮椎体成形术(PVP)分别联合射频消融术(RFA)与^(125)I粒子植入术治疗脊柱转移瘤脊髓压迫症(MSCC)的疗效。方法选取2017年1月~2019年12月我院收治的40例脊柱转移瘤导致脊髓压迫症的患者为研究对象,按照治疗方案的不同将其分为2组,A组20例,B组20例,A组手术方案为PVP联合RFA治疗组,B组为PVP联合125I粒子植入术治疗组。观察两组的镇痛效果、脊髓狭窄率及生存率。结果40例患者均顺利完成手术,其中A组术前、术后1周、术后1个月及3个月VAS评分分别为7.22±2.39、4.39±2.17、3.07±2.31及2.14±2.18,椎管狭窄率术前、术后1个月、3个月分别为37.65%±11.23%、22.27%±10.54%、17.07%±14.62%;B组相应时间VAS评分分别为7.82±0.95、5.18±1.88、2.80±1.78及1.29±1.64,椎管狭窄率分别为41.06%±11.43%、27.36%±9.69%、19.70%±11.59%。两组患者术后1周、1个月、3个月VAS评分均较术前均有下降(P<0.05),两组间VAS比较无明显统计学差异(P>0.05)。术后1个月和3个月脊髓压迫程度均较术前缓解,术后1个月观察A组脊髓压迫缓解优于B组(P<0.05),术后3个月2组疗效无明显差异(P>0.05)。两组术后6个月生存率比较,B组优于A组。结论经皮椎体成形术联合射频消融术与联合^(125)I粒子植入术治疗转移性脊髓压迫症均有较理想的疗效,术后1个月对脊髓压迫的缓解联合射频消融组的治疗方案略有优势。

Objective To compare the effects of percutaneous vertebroplasty(PVP)combined with radiofrequency ablation(RFA)and ^(125)I seed implantation in the treatment of metastatic spinal cord compression(MSCC).Methods From January 2017 to December 2019,40 patients with MSCC were divided into two groups undergoing PVP+RFA(20)or PVP+^(125)I seed implantation(20).The analgesic effect(VAS score),spinal stenosis rate and survival rate of the two groups were compared.Results The treatment was completed on all patients.The VAS scores of PVP+RFA and PVP+125I seed implantation were significantly(P<0.05)lower at 1 week(4.39±2.17,5.18±1.88),1 month(3.07±2.31,2.80±1.78),and 3 months(2.14±2.18,1.29±1.64)after than that before(7.22±2.39,7.82±0.95)treatment without significant difference between the two groups.In both PVP+RFA and PVP+125I seed implantation groups,spinal cord compression was relieved with reduction of spinal stenosis rates at 1 month(22.27%±10.54%,27.36%±9.69%)and 3 months(17.07%±14.62%,19.70%±11.59%)after treatment compared to pre-treatment rates(37.65%±11.23%,41.06%±11.43%).The PVP+RFA group performed better with lower rates of spinal stenosis(22.27%±10.54%)than that of PVP+125I seed implantation(27.36%±9.69%)at 1 month after treatment(P<0.05).There was no significant difference(P>0.05)in the rates of spinal stenosis between the two groups(17.07%±14.62%,19.70%±11.59%)at 3 months after treatment.The 6-month survival rate of PVP+^(125)I seed implantation was better than that of PVP+RFA.Conclusion Both PVP+RFA and PVP+125I seed implantation are useful for the treatment of MSCC.PVP+RFA has a slight advantage in relieving spinal cord compression at 1 month.