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

作　　者：庄怀铭[1] 温世锋[2] 徐耿填[1] 黄青[1] Huai-ming Zhuang;Shi-feng Wen;Geng-tian Xu;Qing Huang(Department of Spine Surgery,the People’s Hospital of Jieyang,Jieyang,Guangdong 522000,China;Department of Spine Surgery,Guangzhou First People’s Hospital,Guangzhou,Guangdong 510180,China)

机构地区：[1]广东省揭阳市人民医院脊柱外科,广东揭阳522000 [2]广东省广州市第一人民医院脊柱外科,广东广州510180

出　　处：《中国现代医学杂志》2018年第34期116-121,共6页China Journal of Modern Medicine

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。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 minimallyinvasive surgery for the treatment of spinal compression fractures caused by metastatic tumors.

关 键 词：骨折 压缩性 椎体成形术 疼痛 介入肿瘤摘除术/外科手术 安全 治疗结果 

分 类 号：R683.2[医药卫生—骨科学]