单双侧椎弓根入路经皮椎体成形联合活检术治疗椎体转移瘤临床效果的比较

Comparison of the clinical efficacy of percutaneous vertebroplasty and biopsy by unilateral and bilateral pedicle approaches for the treatment of vertebral metastasis

目的探讨单双侧椎弓根入路经皮椎体成形联合活检术治疗椎体转移瘤临床疗效及活检阳性率的差异。方法回顾性选择临沂市肿瘤医院2020年6月至2022年7月诊治的82例椎体转移瘤患者,分别采用单侧椎弓根入路(39例,57节椎体,单侧组)与双侧椎弓根入路(43例,52节椎体,双侧组)病理活检并填充骨水泥修复伤椎。比较两组临床疗效及活检阳性率的差异。结果两组患者术后视觉模拟量表(VAS)评分和功能障碍指数(ODI)评分均较术前有明显改善(P<0.05),但两组间比较差异无统计学意义(P>0.05)。双侧组单节手术时间长于单侧组[(44.81±13.01)min比(31.84±11.87)min],差异有统计学意义(P<0.05)。双侧组单节骨水泥填充量高于单侧组[(4.87±0.92)ml比(4.18±0.90)ml],差异有统计学意义(P<0.05)。两组骨水泥渗漏率比较差异无统计学意义(P>0.05)。两组病理阳性率比较差异无统计学意义(P>0.05)。结论单双侧椎弓根入路经皮椎体成形联合活检术对椎体转移瘤患者的疼痛症状及身体功能均具有明显改善作用,临床疗效和活检阳性率基本相当,但单侧入路具有操作步骤少、手术时间短、骨水泥填充量少的优势。

Objective To retrospectively compare the clinical efficacy of percutaneous vertebroplasty and biopsy by unilateral and bilateral pedicle approaches for the treatment of vertebral metastasis.Methods From June 2020 to July 2022,a total of 82 patients with vertebral metastasis underwent percutaneous vertebroplasty and biopsy treated in Linyi Cancer Hospital were enrolled,39 patients with 57 vertebral bodies were performed by unilateral pedicle approach(unilateral group)and 43 patients with 52 vertebral bodies were performed by bilateral pedicle approaches(bilateral group),used bone cement filling vertebral bodies after biopsy.The clinical efficacy and the positive rate of biopsy were compared between the two groups.Results Both groups experienced significant pain relief in the Visual Analog Scale(VAS)score and improvement in the Oswestry Disability Index(ODI)score after operation(P<0.05),but there were no significant differences between the two groups(P>0.05).The operative time for a single vertebra,volume of bone cement in unilateral group were less than those in the bilateral group:(44.81±13.01)min vs.(31.84±11.87)min,(4.87±0.92)ml vs.(4.18±0.90)ml,there were significant differences(P<0.05).There were no significant differences in the incidence of bone cement leakage and the positive rate of biopsy between both groups(P>0.05).Conclusions Percutaneous vertebroplasty and biopsy by unilateral and bilateral pedicle approaches are significant improvement for symptoms and functions of patients with vertebral metastasis.The clinical efficacy and the positive rate of biopsy are similar.But the former has easier operation procedure,shorter operative time and less volume of bone cement.