经皮椎体成形术治疗多节段溶骨性脊柱转移瘤的疗效评价

Evaluation of the efficacy of percutaneous vertebroplasty for the treatment of multi-segment osteolytic spinal metastatic tumors

目的分析单次经皮椎体成形术(PVP)治疗多节段溶骨性脊柱转移瘤的安全性和有效性。方法采用回顾性病例分析方法,选取2013年1月—2019年12月首都医科大学附属北京友谊医院收治的113例采用PVP治疗的多节段溶骨性脊柱转移瘤患者的临床资料,其中男性50例,女性63例;年龄47~85岁,平均(66.9±1.52)岁。根据接受手术患者的患椎数量分为两组:常规手术数量组(n=72),每次手术时最多3个椎体接受PVP治疗;多椎体手术组(n=41),在一次手术中超过3个椎体接受PVP治疗。在手术前、术后各随访时间点评估患者疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、一般健康状况(GH)和精神健康状况(MH),评估手术临床疗效。评估患者的并发症,进行安全性观察。计量资料以均数±标准差(±s)表示,组间比较采用独立样本t检验,组内比较采用配对样本t检验;计数资料组间比较采用χ^(2)检验。结果术后6个月,常规手术数量组ODI评分为(35.28±1.74)%,GH评分为(57.85±2.11)分,MH评分为(61.20±3.67)分,均较术前改善,差异具有统计学意义(P<0.05)。术后6个月,多椎体手术组ODI评分为(35.67±1.92)%,GH评分为(64.12±1.35)分,MH评分为(59.80±3.81)分,也均较术前改善,差异具有统计学意义(P<0.05)。术后6个月,两组患者之间ODI评分和MH评分方面差异无统计学意义(P>0.05)。术后1周,常规手术数量组患者的疼痛VAS评分[(3.51±0.21)分]较多椎体手术组[(3.98±0.32)分]低,差异具有统计学意义(P<0.05)。常规手术数量组患者的GH评分在术后6个月较多椎体手术组改善明显,差异具有统计学意义(P<0.05)。常规手术数量组21个椎体发生骨水泥渗漏,多椎体手术组24个椎体发生骨水泥渗漏,渗漏率分别为14.8%和13.0%,两组差异无统计学意义(P>0.05)。结论单次PVP手术能够安全、有效地缓解多节段溶骨性脊柱转移瘤的疼痛,改善脊柱活动功能,改善精神健康状况,减轻功能障碍。但短期疼痛缓解和远期一般健康改善低于常规手术数量的患者。

ObjectiveTo analyze the safety and efficacy of single percutaneous vertebroplasty(PVP)in the treatment of multi-segment osteolytic spinal metastases.MethodsA retrospective analysis was conducted on 113 patients with multi-segment osteolytic spinal metastases treated with PVP at Beijing Friendship Hospital,Capital Medical University from January 2013 to December 2019,including 50 males and 63 females.The age ranged from 47 to 85 years,with a mean of(66.9±1.52)years.Patients were divided into two groups based on the number of affected vertebrae undergoing surgery:the conventional surgery group(n=72),with a maximum of three vertebral bodies undergoing PVP during each surgery;the multivertebral surgery group(n=41),received PVP on more than three vertebral bodies in one surgery.Visual analogue scale(VAS)of pain,Oswestry disability index(ODI),general health status(GH),and mental health status(MH)were assessed before and after PVP to evaluate the efficacy of the procedure.Complications of the patients were systematically assessed to evaluate safety.Measurement data was expressed as mean±standard deviation(±s),independent sample t-test was used for inter-group comparison,and paired sample t-test was used for intra-group comparison;the comparison of count data was conducted using Chi-square test.ResultsAfter 6 months of surgery,the ODI score,GH score and MH score of the conventional surgery group was(35.28±1.74)%,57.85±2.11 and 61.20±3.67,all of which improved significantly compared to before surgery,and the difference was statistically significant(P<0.05).After 6 months of surgery,the ODI score,GH score and MH score of the multivertebral surgery group was(35.67±1.92)%,64.12±1.35 and 59.80±3.81,all of which improved significantly compared to before surgery,and the difference was statistically significant(P<0.05).There was no significant difference in ODI score and MH score between the two groups after 6 months of surgery(P>0.05).At one week after surgery,the pain VAS score in the conventional surgery group(3.51±0.21)was lower than that in the multivertebral surgery group(3.98±0.32),and the difference was statistically significant(P<0.05).GH score in the conventional surgery group showed significantly greater improvement than that in the multivertebral surgery group after 6 months of surgery,and the difference was statistically significant(P<0.05).Bone cement leakage occurred in 21 vertebra of the conventional surgery group,and 24 vertebra of the multivertebral surgery group,with leakage rates of 14.8%and 13.0%,respectively,with no statistical significance between the two groups(P>0.05).ConclusionsSingle PVP surgery can safely and effectively alleviate the pain of multi-segment osteolytic spinal metastases and improve spinal mobility.Meanwhile,improving mental health and reducing functional impairments.But the short-term pain relief and long-term general health of the multivertebral surgery group were lower than those of the conventional surgery group.