射频消融联合经皮椎体成形术治疗脊柱转移瘤的疗效分析

Radiofrequency ablation combined with percutaneous vertebroplasty in the treatment of spinal metastasis

中文关键词:  脊柱转移瘤  射频消融术  经皮椎体成形术  骨水泥

英文关键词:Spinal metastasis  Radiofrequency ablation  Percutaneous vertebroplasty  Bone cement

中文摘要:

  【摘要】 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。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical outcomes of radiofrequency ablation combined with percutaneous vertebroplasty in the treatment of spinal metastasis. Methods: Fifty-five patients with spinal metastasis treated from October 2012 to March 2014 were retrospectively analyzed. 28 patients were only treated with percutaneous vertebroplasty(PVP group) and the other 27 patients were treated with radiofrequency ablation combined with percutaneous vertebroplasty(PVP+RFA group). PVP group comprised 20 males and 7 females with a mean age of 47.0±8.5 years. Similarly, 19 males and 9 females were in PVP+RFA group with a mean age of 49.0±7.6 years. The clinical outcomes were assessed by visual analogue scale(VAS) and Karnofsky(KPS). Recorded data also included the percentage of bone cement leakage and tumor recurrence rate. Survival analysis was evaluated by Kaplan-Meier. Results: The period of follow-up ranged from 6 to 18 months with a mean time of 11.68±3.29 months(PVP group) and 12.19±3.33 months(PVP+RFA group), the VAS score improved at 6 months after operation in both groups(from 7.86±0.85 to 3.07±0.90 in group PVP, and from 7.67±0.96 to 2.96±0.94 in group PVP+RFA). Pain was relieved in all the patients, but there was no significant difference between the two groups preoperatively and at 6 months after operation(P＞0.05). The mean KPS in both groups increased after surgery. But no significant difference was found between the two groups(P＞0.05). The percentage of bone cement leakage was 42.86% in PVP group and 11.11% in PVP+RFA group. The tumor recurrence rate of the two groups was 32.14%(PVP group) and 7.41%(PVP+RFA group) respectively. There were significant differences of the percentage of bone cement leakage and the tumor recurrence rate in the two groups(P＜0．05). The median survival time of PVP group was 12 months and 13 months of PVP+RFA group. The survival time was similar in the two groups after operation. No significant difference was found between the two groups(P＞0.05). Conclusions: In treatment for spinal metastasis, radiofrequency ablation combined with percutaneous vertebroplasty not only gets similar effect with simple percutaneous vertebroplasty, but also reduces the percentage of bone cement leakage and controlled tumor progression in the early stage after operation.