微波消融联合骨水泥注射治疗脊柱附件转移瘤

Microwave Ablation Combined With Bone Cement Injection in the Treatment of Spinal Appendage Metastases

目的 探讨微波消融联合骨水泥注射治疗脊柱附件转移瘤的疗效。方法 2017年3月~2021年11月,对32例脊柱附件转移瘤行微波消融联合骨水泥注射。共49个脊柱附件溶骨性病变(17例单发,15例多发),在CT引导下行微波消融联合骨水泥注射。观察术后病变附件影像学变化;术后1周、3个月、6个月、12个月用视觉模拟评分(Visual Analogue Scale, VAS)评估疼痛缓解程度;术后1年用日常生活能力量表(Activity of Daily Living Scale, ADL)评估生活质量。结果 32例手术均顺利,1例病椎附件骨水泥渗漏,无椎管内渗漏和肺栓塞等并发症。术后1周、3个月、6个月、12个月VAS评分均低于术前(P<0.05);术后1年ADL评分高于术前(P<0.05)。术后1年时,1例2个附件肿瘤进一步浸润并突入椎管内,1例1个附件肿瘤侵入相邻椎体内,其余附件及椎体未见肿瘤进一步浸润侵袭。结论 微波消融联合骨水泥注射治疗脊柱附件转移瘤安全可行,具有良好的止痛效果,能够显著改善生活质量,并可维持脊柱附件完整,同时延缓椎管内和椎体内肿瘤浸润。

Objective To explore the clinical effect of microwave ablation(MWA) combined with bone cement injection in the treatment of spinal appendage metastases. Methods From March 2017 to November 2021, MWA combined with bone cement injection was performed in 32 cases of spinal appendage metastases. A total of 49 osteolytic lesions of spinal appendage(17 single and 15 multiple) were subjected to MWA combined with bone cement injection under CT guidance. Post-operative imaging changes of the lesions were observed. Pain relief was assessed by the Visual Analogue Scale(VAS) at 1 week, 3 months, 6 months and 12 months after surgery, and the quality of life was assessed by the Activity of Daily Living Scale(ADL) at 1 year after surgery. Results All the 32 procedures were successfully completed. Cement leakage from the diseased vertebral attachment was observed in 1 case, and no complications such as intradiscal leakage or pulmonary embolism occurred. The VAS scores at 1 week, 3 months, 6 months and 12 months after surgery were lower than those before surgery(P<0.05). The ADL scores at 1 year after surgery were higher than those before surgery(P<0.05). At 1 year after surgery, 2 appendage tumors in 1 case infiltrated further and protruded into the vertebral canal, and 1 appendage tumor in 1 case invaded into the adjacent vertebral body, while no further tumor infiltration was seen in the remaining adnexal and vertebral bodies. Conclusions Microwave ablation combined with bone cement injection is safe and feasible for the treatment of spinal appendage metastases. It provides good pain relief, significantly improves quality of life, maintains the integrity of the spinal adnexa, and delays tumor infiltration in the spinal canal and vertebral body.