脊柱转移瘤并神经压迫的分离减压微波消融和椎体成形△（开放获取）

Separation decompression, microwave ablation and vertebroplasty for spinal metastases complicated with nerve compression (Open Access)

摘要:

[目的]评估分离减压联合微波消融椎体成形治疗脊柱转移瘤合并神经压迫症状的临床疗效。[方法]回顾性分析 2018 年 3 月—2023 年 6 月收治的 26 例接受“分离手术”联合微波消融椎体成形的脊柱转移瘤合并神经压迫症状患者的临床资料，记录手术时间、术中出血量、微波消融时间、骨水泥注入量。比较术前及术后随访期间脊髓神经功能 ASIA 分级、疼痛视觉模拟评分（visual analogue scale, VAS）、Oswestry 功能障碍指数（Oswestry disability index, ODI）、Karnofsky 功能状态评分（Karnofsky per- formance scale, KPS），评价临床疗效。定期复查术区 CT 和 MRI，观察术区骨水泥周缘骨质及软组织内肿瘤浸润情况，评价肿瘤局部控制情况。[结果]26 例患者均顺利完成手术，手术时间（127.3±51.4）min、 术中出血量（358.5±241.7）ml，微波消融时间 （12.2±3.7）min，骨水泥注入量（4.7±2.1）ml，术中无脊髓及神经根损伤，内固定及骨水泥位置良好。随时间自术前、术后 1、3、6 个月的推移，VAS 疼痛评分 [(8.2±1.4), (3.4±1.1), (2.6±0.6), (2.0±0.5), P＜0.001]、ODI [(83.7±11.3), (35.2±7.6), (14.2±2.4), (13.2±2.3), P＜ 0.001] 和 KPS 评分 [(41.7±16.4), (68.4±16.3), (76.4±15.6), (80.2±11.6), P＜0.001] 均显著改善；此外，ASIA 神经功能评级亦显著改善 （P＜0.05)。至术后 6 个月，除 3 例患者因原发疾病死亡外，所有患者术区肿瘤控制良好，无肿瘤复发。[结论]分离减压联合微波消融和椎体成形术可以有效缓解疼痛，解除神经压迫并重建脊柱稳定性，可以控制局部肿瘤，改善患者生存质量。

Abstract:

[Objective] To evaluate the clinical efficacy of separation decompression combined with microwave ablation and vertebroplasty in the treatment of spinal metastases complicated with nerve compression. [Methods] A retrospective study was conducted on 26 patients who underwent separation decompression combined with microwave ablation and vertebroplasty for spinal metastasis complicated with nerve compression from March 2018 to June 2023. The operation time, intraoperative blood loss, microwave ablation time and bone cement injection amount were recorded. ASIA neurological scale, visual analogue scale (VAS) for pain, Oswestry disability index (ODI) and Karnofsky performance scale (KPS) were used to evaluate clinical outcomes. In addition, CT and MRI were periodically reviewed to observe the tumor infiltration in the bone and soft tissue around the bone cement in the operative area, and to evaluate the local control of the tumor. [Results] All the 26 patients had operation performed successfully with operation time of (127.3±51.4) min, the intraoperative blood loss of (358.5±241.7) ml, the microwave ablation time of (12.2±3.7) min, and the injected bone cement of (4.7±2.1) ml. However, there was no spinal cord and nerve root injury in anyone of them, with good position of implants and bone cement. The VAS for pain [(8.2±1.4), (3.4±1.1), (2.6±0.6), (2.0±0.5), P＜0.001], ODI [(83.7±11.3), (35.2±7.6), (14.2±2.4), (13.2±2.3), P＜0.001] and KPS scores [(41.7±16.4), (68.4±16.3), (76.4±15.6), (80.2±11.6), P＜0.001] significantly improved as time went preoperatively, 1 month, 3 months and 6 months postoperatively. Furthermore, the ASIA neurological scale significantly improved over time (P＜0.05). At 6 months postoperatively, all patients had tumor well controlled in the operative area without tumor recurrence, except 3 patients who died due to the primary disease. [Conclusion] The separation decompression combined with microwave ablation and verteboplasty do effectively relieve pain, relieve nerve compression and restore spinal stability, control local tumors and improve patients' quality of life.