依据Tomita评分的后凸成形术治疗脊柱转移瘤  

Kyphoplasty based on Tomita score for spinal metastatic tumors

作　　者：何文野 包肇华[1] 季一鸣[1] HE Wen-ye;BAO Zhao-hua;JI Yi-ming(Depart-merit of Orthopedics,The First Affiliated Hospital,Suzhow University,Suzhou 215005,China)

机构地区：[1]苏州大学附属第一医院,江苏省苏州市215006

出　　处：《中国矫形外科杂志》2018年第23期2113-2117,共5页Orthopedic Journal of China

基　　金：国家自然科学基金项目(编号:81601922)

摘　　要：[目的]评价球囊扩张椎体后凸成形术在治疗Tomita评分4～7分脊柱转移性肿瘤患者的安全性和疗效。[方法]回顾2014年1月～2017年7月的脊柱转移瘤患者,对其进行Tomita评分,选择评分在4～7分的患者31例共65个椎体,对其进行经皮球囊扩张椎体后凸成形术。比较手术前后患者的VAS评分和ODI指数,采用WHO疼痛缓解标准评价随访时症状改善,拍摄X线片,测量比较后凸畸形角(Cobb角)、椎体前缘、中部高度。[结果]所有患者均顺利完成手术,无严重并发症。除1例患者死亡外,30例患者随访12～25个月,平均(17.83±2.86)个月。与术前相比,术后VAS评分、ODI指数显著减少,差异有统计学意义(P<0.05)。按WHO疼痛缓解标准,术后1年时疼痛缓解73.33%。影像测量方面,术后Cobb角较术前降低,椎体前缘及中部高度较术前增高,差异均有统计学意义(P<0.05),但术3 d与术后1年,影像测量指标变化差异无统计学意义(P>0.05)。[结论]对于Tomita评分4～7分的患者应用球囊扩张椎体后凸成形术,能迅速缓解胸腰椎转移瘤引起的疼痛,有效恢复病椎高度,提高生存质量。[Objective] To evaluate safety and clinical outcomes of kyphoplasty for osteolytic spinal metastatic tumors in patients with Tomita score of 4～7. [Method] A retrospective study was done on 31 patients(65 vertebrae) who underwent percutaneous kyphoplasty for spinal metastatic tumors with Tomita score of 4 to 7. The visual analogue scale(VAS) for pain and Oswestry disability index(ODI) were compared pre-postoperatively. World Health Organization(WHO) criteria for pain relief was used for evaluation of the symptoms at the latest follow-up. Radiographic measurements, such as local kyphosis angle(Cobb angle), anterior vertebral height and middle vertebral height were also assessed before and after surgery. [Results] All the 31 patients had operation performed smoothly without serious complications. Except 1 patient who died of cancer, the remaining 30 patients were followed for 12 to 25 months with an average of(17.83±2.86) months. Both the VAS and ODI significantly decreased after operation compared with those before operation(P<0.05). At 1 year after operation, pain relief achieved in73.33% of the 30 patients based on WHO criteria. In term of radiographic measurements, the Cobb angle significantly reduced,while the anterior and middle vertebral heights significantly increased after operation compared with those preoperatively(P<0.05), whereas aforesaid parameters kept unchanged remarkably between 3 days postoperatively and the latest follow up(P>0.05). [Conclusion] Percutaneous kyphoplasty does quickly relieve pain caused by thoracolumbar metastasis, effectively restore vertebral height and improve the quality of life of patients with Tomita score of 4 to 7.

关 键 词：肿瘤转移 脊柱病理骨折 后凸成形术 

分 类 号：R738.1[医药卫生—肿瘤]