介入肿瘤摘除术联合经皮椎体成形术治疗脊柱 转移性肿瘤椎体压缩性骨折的 疗效及安全性评价

Safety and efficacy of percutaneous vertebroplasty and interventional tumor removal for vertebral compression fractures caused by spinal metastatic tumors

摘要:

目的 探讨介入肿瘤摘除术（ITR）联合经皮椎体成形术（PVP）治疗肿瘤椎体压缩性骨折的疗效 及其安全性。方法 选取2010 年10 月至2014 年10 月揭阳市人民医院接诊治疗的脊柱转移性肿瘤椎体压缩性 骨折患者76 例为研究对象，依据治疗方法的不同分为PVP 联合ITR 组37 例（48 椎）和PVP 组39 例（52 椎）。 术后3 d 行脊柱CT，X 射线检查骨水泥渗漏发生情况。依据两组患者术前24 h 及术后24 h、1、3、6、12 及24 个月随访中疼痛情况评价治疗效果，依据两组术中骨水泥注射量、住院时间及并发症的发生情况评价其安全性。 结果 76 例（100 椎）患者均完成手术，未发生出血、感染、心肺功能障碍等并发症。两组术后24 h 及术后1、3、6、 12 及24 个月视觉模拟评分（VAS）结果显示，PVP+ITR 组与PVP 组患者的VAS 评分变化趋势有差异，与PVP 组患者比较，PVP+ITR 组VAS 评分较低，相对镇痛效果较好（P <0.05）。两组患者的总体生存期、平均住院时 间比较差异无统计学意义（P >0.05）。PVP 联合ITR 组椎体骨水泥注射量高于PVP 组，而渗漏发生率低于PVP 组（P <0.05）。结论 PVP 联合ITR 具有镇痛性好、骨水泥渗漏率低、疗效确切的优点，是微创手术治疗脊柱转 移瘤所致压缩性骨折的有效方法。

Abstract:

Objective To investigate the efficacy and safety of interventional tumor removal (ITR) combined with percutaneous vertebroplasty (PVP) in the treatment of vertebral compression fractures. Methods A total of 76 patients with vertebral compression fractures combined spine metastatic tumors were selected in the People’s Hospital of Jieyang from October 2010 to October 2014. The patients were divided into a PVP coupled with ITR group (37 cases, 48 vertebrae) and a PVP group (39 cases, 52 vertebra) according to the different treatment methods. CT and X-ray examination were performed 3 d after operation to detect the occurrence of cement leakage. The treatment effect was evaluated according to the Visual Analogue Scales score 24 h before operation and 24 h, 1, 3, 6, 12 and 24 m after surgery. Besides, the volume of bone cement injected, the period of hospitalization and the occurrence of complications were collected to analyze the safety. Results PVP procedures with and without ITR were successful in all 76 patients (100 involved vertebrae). There was no complication as infection, bleeding, pulmonary embolism or cardiac arrest during or after the procedures. The clinical assessment obtained at the start and follow-up indicated that the PVP coupled with ITR provided a significantly better pain relief than PVP alone (P < 0.05). There was no significant difference between the two groups in the overall survival duration or the average hospitalization period (P > 0.05). The volume of bone cement injected was larger but the incidence of cement leakage was significantly reduced in the PVP coupled with ITR group compared to the PVP group (P < 0.05). Conclusions Treatment of vertebral compression fractures with PVP and ITR results in good analgesia, low leakage incidence of bone cement and definite therapeutic effect. It is an effective minimally-invasive surgery for the treatment of spinal compression fractures caused by metastatic tumors.