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目的 :观察射频消融联合经皮椎体成形术治疗脊柱转移瘤的临床疗效。方法 :回顾性分析2012年10月~2014年3月收治的55例脊柱溶骨性转移瘤患者的临床资料,其中28例行经皮椎体成形术(PVP组),27例行射频消融联合经皮椎体成形术(PVP+RFA组)。PVP组中男20例,女7例,年龄47.0±8.5岁,PVP+RFA组中男19例,女9例,年龄49.0±7.6岁。采用疼痛视觉模拟评分(visual analogue scale,VAS)评估患者疼痛情况,卡氏功能状态评分(Karnofsky,KPS)评价患者功能状态,观察两组患者骨水泥外渗情况及术后肿瘤复发率,并应用Kaplan-Meier法对全部患者进行生存分析。结果:随访6~18个月,PVP组11.68±3.29个月,PVP+RFA组12.19±3.33个月。PVP组VAS评分从术前的7.86±0.85分降至3.07±0.90分,PVP+RFA组从术前的7.67±0.96分降至2.96±0.94分,两组术后与术前比较均有统计学差异,疼痛明显缓解(P<0.05);术前和术后6个月时两组VAS评分均无显著性差异(P>0.05)。两组术后KPS评分较术前均有所提高,两组术后比较无统计学差异(P>0.05)。PVP组骨水泥外渗率为42.86%,PVP+RFA组为11.11%;PVP组肿瘤复发率为32.14%,PVP+RFA组为7.41%,两组骨水泥外渗率及术后肿瘤复发率均有统计学差异(P<0.05)。PVP组术后中位生存时间为12个月,PVP+RFA组为13个月,两组术后生存率比较无显著性差异(P>0.05)。结论:PVP+RFA治疗脊柱溶骨性转移瘤可取得与PVP相似的临床疗效,并能有效减少骨水泥外渗及术后早期肿瘤进展。
Objective: To observe the clinical effect of radiofrequency ablation combined with percutaneous vertebroplasty in the treatment of spinal metastases. Methods: The clinical data of 55 patients with osteolytic leptomeningeal metastases from October 2012 to March 2014 were retrospectively analyzed. 28 patients underwent percutaneous vertebroplasty (PVP group) and 27 patients underwent radiofrequency catheter ablation Percutaneous vertebroplasty (PVP + RFA group). There were 20 males and 7 females in PVP group, with a mean age of 47.0 ± 8.5 years. There were 19 males and 9 females in PVP + RFA group, aged 49.0 ± 7.6 years. Pain was assessed by visual analogue scale (VAS), Karnofsky (KPS) was used to assess the functional status of the patients, and the bone cement infiltration and postoperative recurrence were observed. Kaplan-Meier method for survival analysis of all patients. Results: The follow-up ranged from 6 to 18 months, PVP group 11.68 ± 3.29 months and PVP + RFA group 12.19 ± 3.33 months. The VAS score of PVP group decreased from 7.86 ± 0.85 points preoperatively to 3.07 ± 0.90 points, PVP + RFA group decreased from 7.67 ± 0.96 points preoperatively to 2.96 ± 0.94 points, there was statistical difference between the two groups (P <0.05). There was no significant difference in VAS score between the two groups before and 6 months after operation (P> 0.05). The postoperative KPS scores of both groups were improved compared with those before operation. There was no significant difference between the two groups (P> 0.05). The rate of bone cement infiltration was 42.86% in PVP group and 11.11% in PVP + RFA group, 32.14% in PVP group and 7.41% in PVP + RFA group, respectively There was a significant difference (P <0.05). The median postoperative survival time was 12 months in PVP group and 13 months in PVP + RFA group, there was no significant difference between the two groups (P> 0.05). CONCLUSION: PVP + RFA can achieve similar clinical efficacy as PVP in the treatment of osteolysis metastases of the spine, and can effectively reduce the extravasation of bone cement and the early postoperative tumor progression.