射频消融辅助椎体次全切除术在脊柱转移瘤中的应用  

Radiofrequency ablation combined with subtotal corpectomy for spinal metastases

作　　者：王国文[1] 韩秀鑫[1] 马育林[1] 多健[1] 杨吉龙[1] 廖志超[1] 

机构地区：[1]天津医科大学附属肿瘤医院骨与软组织肿瘤科,300600

出　　处：《中华骨科杂志》2011年第9期938-943,共6页Chinese Journal of Orthopaedics

摘　　要：目的探讨射频消融（radiofrequency ablation，RFA）辅助椎体次全切除术治疗脊柱转移瘤的安全性和临床疗效。方法2009年4月至2010年3月采用椎体次全切除术治疗并获得随访的脊柱转移瘤患者29例。RFA辅助椎体次全切除术（RFA辅助组）13例，男7例，女6例；年龄47-72岁，平均5813岁。椎体次全切除术（单纯切除组）16例，男7例，女9例；年龄46-71岁，平均57．8岁。两组年龄、性别、Tomita分型差异无统计学意义。术后1个月及6个月评估疼痛视觉模拟评分（visual analogue scale，VAS），术后6个月评估Frankel脊髓损伤分级。结果RFA辅助组术前、术后1个月、6个月VAS分别为（8．88±0．36）、（3．76±0．33）、（3．35±0．38）分，单纯切除组分别为（8．96±0．39）、（3．81±0.48）、（3．41±0．42）分，术后1个月、6个月与术前比较差异均有统计学意义，两组间差异均无统计学意义。RFA辅助组手术时间、术中出血量、复发率分别为（216．54±113．77）min、（1084．62±539．82）ml、30．8％，单纯切除组分别为（302．50±80．44）min、（1625．00±724．34）ml、75．0％，差异均有统计学意义。两组Frankel脊髓损伤分级与术前比较平均改善1级。结论应用RFA辅助能够缩短椎体次全切除术的手术时间，减少术中出血量和降低复发率。Objective To investigate the safety and efficacy of combined treatment with subtotal corpectomy and radiofrequency ablation （RFA） for spinal metastases. Methods From April 2009 to March 2010, 29 patients with spinal metastases who received subtotal corpectomy were analyzed. Sixteen patients （7 men and 9 women） with an average of 57.8 years having received subtotal corpectomy alone were selected for comparison （the subtotal eorpectomy group）. Thirteen patients （7 men and 6 women） with an average of 58.3 years having received subtotal eorpectomy combined with RFA were chosen as subjects of this study （the RFA combination group）. There were no significant differences between the two groups with respect to the patient＇s age, gender, and Tomita type. Pain levels pre-and post-procedure were assessed by the visual analogue scale （VAS）, and neurologic deficit were evaluated by the Frankel scale. Results The VAS in RFA combination group were 8.88±0.36, 3.76±0.33, 3.35±0.38 in preoperation, 1 month, and 6 months post- operatively, respectively. The VAS in subtotal corpectomy group were 8.96±0.39, 3.81±0.48, 3.41±0.42 in preoperation, 1 month, and 6 months postoperatively, respectively. The VAS in both groups showed statistical significance at each time point, there was no statistically difference between the two groups. The operate time in RFA combination group and subtotal eorpectomy group were （216.54±113.77） min and （302.50±80.44） min, respectively. The blood loss of the two groups were （1084.62±539.82） ml and （1625.00±724.34） ml, respectively. The recurrent rate of the two groups were 30.8% and 75.0%, respectively. The RFA combination group were lower in operate time, blood loss and recurrent rates than subtotal corpectomy group. Conclusion Compared with the subtotal corpectomy, the RFA combination can reduce the blood loss, operation time, and the recurrent rates.

关 键 词：导管消融术 脊柱 肿瘤转移 

分 类 号：R687.3[医药卫生—骨科学]