微波椎体成形椎弓钉固定治疗脊柱转移瘤△

Microwave ablation combined with vertebroplasty and pedicle screw fixation for spinal metastases

摘要:

[目的] 评价微波消融术联合椎体成形及椎弓根内固定 (microwave ablation combined with vertebroplasty and pedicle screw fixation, MWVPS) 治疗脊柱转移瘤的临床疗效。[方法] 回顾性分析 2018 年 1 月—2020 年 4 月本院脊柱外科治疗的胸腰椎转移瘤 37 例患者的临床资料。根据术前医患沟通结果，15 例采用 MWVPS 治疗，而其他 22 例采用单纯经皮椎体成形术 (percutaneous vertebroplasty, PVP)治疗。比较两组围手术期、随访和影像资料。[结果]两组均顺利完成手术，术中均未发生脊髓及神经根损伤。MWVPS 组的手术时间、术中出血量、骨水泥注入量、住院时间均显著多于 PVP 组(P＜0.05)，但 MWVPS 组骨水泥渗漏率显著低于 PVP 组 (P＜0.05)，MWVPS 组其他并发症发生率显著高于 PVP 组 (P＜0.05)。所有患者随访时间平均 (14.9±1.0)个月。两组术后 VAS、ECOG 评分均较术前显著减少(P＜0.05)。术前、术后 3 个月两组 VAS、ECOG 评分的差异均无统计学意义(P＞0.05)，末次随访，MWVPS 组 VAS、ECOG 评分均显著优于 PVP 组(P＜0.05)。影像方面，与术前相比，两组术后 6 个月病椎高度显著增加(P＜0.05)，局部后凸 Cobb 角显著减小(P＜0.05)。术前两组间病椎高度、Cobb 角差异无统计学意义 (P＞0.05)，术后 6 个月和末次随访时 MWVPS 组上述指标均显著优于 PVP 组(P＜0.05)。[结论] 微波消融联合椎体成形和椎弓根内固定治疗脊柱转移瘤在安全性和中期疗效方面均优于单纯椎体成形术。

Abstract:

[Objective] To evaluate the clinical outcomes of microwave ablation combined with vertebroplasty and pedicle screw fixa- tion (MWVPS) for spinal metastases. [Methods] A retrospective study was performed on 37 patients who received surgical treatment for tho- racolumbar metastatic tumors in our hospital from January 2018 to April 2020. Based on preoperative doctor-patient communication, 15 pa- tients received MWVPS, while the other 22 patients received percutaneous vertebroplasty (PVP) alone. The perioperative, follow-up and im- aging data were compared between the two groups. [Results] All patients in both groups had surgical procedures performed successfully with- out spinal cord and nerve root injury during the operation. The MWVPS group consumed significantly longer operation time, associated with significantly more intraoperative blood loss, more bone cement injected and longer hospital stay than the PVP group (P＜0.05), while the MWVPS group had significantly lower ratio of bone cement leakage than PVP group (P＜0.05), regardless of the fact that the MWVPS group had significantly higher rate of incision complication than the PVP group (P＜0.05). With time of follow-up lasted for (14.9±1.0) months on a mean, the VAS and ECOG scores significantly continuously decreased in MWVPS group, while curve-likely changed in PVP group (P＜ 0.05). Although there were no significant differences in VAS and ECOG scores between the two groups before surgery and 3 months after sur- gery (P＞0.05), the MWVPS group proved significantly superior to the PVP group at the latest follow-up in terms of VAS and ECOG scores (P＜0.05). Radiographically, the height of the affected vertebrae significantly increased (P＜0.05), whereas the local kyphotic Cobb angle sig- nificantly decreased in both groups 6 months after surgery compared with those before surgery (P＞0.05). There was no significant difference in the vertebral height and Cobb angle of the affected vertebrae between the two groups before surgery (P＞0.05), whereas the MWVPS group was significantly better than PVP group in above parameters at 6 months and the last follow-up (P＜0.05). [Conclusion] Microwave ablation combined with vertebroplasty and pedicle screw fixation is superior to vertebroplasty alone in terms of safety and medium-term efficacy for spinal metastases.