经皮椎体成形术+^(125)I粒子植入与开放手术治疗脊柱转移癌疗效及预后对比研究

A comparative study of the efficacy and prognosis of percutaneous vertebroplasty with I-125 seed implantation and open surgery for spinal metastases

目的探讨脊柱转移癌外科治疗方法的选择、疗效及预后。方法选取2010—2018年间接受经皮椎体成形术联合^(125)I粒子植入(PVPI)或开放手术治疗的114例脊柱转移癌患者资料,应用倾向得分匹配分析得到32例PVPI组与32例开放手术组。比较两组患者Tomita评分、修正Tokuhashi评分、脊髓损伤分级(Frankel)、脊柱肿瘤不稳定评分(SINS)、疼痛视觉模拟评分(VAS)、功能状态评分(KPS)、术中出血量、术后相关并发症以及远期生存时间差异。Kaplan-Meier生存分析,并Cox模型多因素分析。结果PVPI组和开放手术组术中出血量、术后VAS评分、KPS评分均不同(均P<0.05)。预后分析示原发肿瘤病理类型、Tomita评分、修正Tokuhashi评分为影响患者远期生存的独立因素(均P<0.05)。结论PVPI和开放手术均可改善脊柱转移癌患者的疼痛症状、功能状态及生活质量,但PVPI具有出血少、创伤小、术后恢复快的优点。对于Frankel分级为D、E级与无脊髓神经功能损伤症状者手术治疗优先推荐PVPI。影响脊柱转移癌患者预后因素主要为原发肿瘤病理类型、Tomita评分及修正Tokuhashi评分。

Objective To investigate the choice,curative effect and prognosis of surgical method for spinal metastases.Methods 114 patients with spinal metastases who underwent percutaneous vertebroplasty combined with I-125 seed implantation(PVPI)or open surgery from June 2010 to January 2018 were enrolled.The analysis of propensity score matching showed that 32 patients with PVPI were successfully matched with 32 patients with open surgery.The Tomita score,modified Tokuhashi score,spinal cord injury grade(Frankel),spinal tumor instability score(SINS),pain visual analogue scale(VAS),functional status score(KPS),intraoperative blood loss,postoperative complications and long-term survival time of two groups were collected.The survival analysis was by Kaplan-Meier method,and multivariable analysis was by Cox models.Results There was a statistically significant difference in intraoperative blood loss between the PVPI group and the open surgery group.The postoperative VAS score and KPS score were statistically significant(all P<0.05).Prognosis analysis showed that the pathological types of primary tumors,Tomita score,and modified Tokuhashi score were independent factors affecting the long-term survival time of patients with spinal metastases(all P<0.05).Conclusions Both PVPI and open surgery can improve the pain symptoms,functional status and quality of life of patients with spinal metastases,but PVPI has the advantages of less bleeding,less trauma,and faster postoperative recovery.For patients who with Frankel grades D,E,and no spinal cord neurological impairment symptoms,PVPI is recommended for surgical treatment.The factors affecting the prognosis of patients with spinal metastases are mainly the pathological type of primary tumor,Tomita score,and modified Tokuhashi score.