应用骨填充网袋椎体成形术治疗胸腰椎溶骨性转移瘤

Bone filling mesh container in the treatment of thoracolumbar osteolytic metastases

中文关键词:  骨填充网袋  椎体成形术  胸腰椎转移瘤  骨水泥渗漏

英文关键词:Bone filling mesh container  Vertebroplasty  Thoracolumbar osteolytic metastases  Bone cement leakage

中文摘要:

  【摘要】 目的：探讨应用骨填充网袋椎体成形术治疗胸腰椎溶骨性转移瘤的临床疗效。方法：2012年10月～2016年10月应用经皮椎体成形术（percutaneous vertebroplasty，PVP）治疗胸腰椎溶骨性转移瘤病例48例，共77个椎体。其中23例37个椎体行传统PVP（传统PVP组），25例40个椎体应用骨填充网袋（bone filling mesh container，BFMCs）行PVP（BFMCs组），两组患者年龄、性别比和椎体分布均无统计学差异。术中在C型臂透视下观察骨水泥渗漏情况，术后第3天采用VAS评分评估患者疼痛缓解情况、根据Oswestry功能障碍指数（Oswestry disability index，ODI）对活动能力改善进行评估，出院前复查X线、CT观察受累椎体高度复位程度。结果：所有患者均顺利完成手术，穿刺成功率为100%，术中未出现肺栓塞、截瘫或围手术期死亡。传统PVP组术中18个椎体（48.6%，18/37）出现骨水泥渗漏，但患者均无骨水泥渗漏的临床症状，BFMCs组术中无1例出现骨水泥渗漏。所有患者术后3d内疼痛缓解，传统PVP组VAS评分由术前7.8±1.3分（5~10分）降至2.4±1.4分（1~4分），BFMCs组VAS评分由术前7.9±1.1分（6~10分）降至2.5±1.3分（1~4分）；ODI传统PVP组由术前（73.4±4.6）%降至（23.6±4.3）%，BFMCs组由术前（74.6±4.9）%降至（23.9±4.5）%。两组术后VAS评分和ODI与术前比较均有显著性差异（P<0.05），两组间术前、术后比较均无显著性差异（P>0.05）。术后病椎前缘和中部高度抬升百分比传统PVP组分别为（3.2±2.6）%、（5.4±4.1）%，BFMCs组分别为（11.8±11.6）%、（22.1±14.7）%，两组比较差异有统计学意义（P<0.05）。结论：对于胸腰椎溶骨性转移瘤患者应用骨填充网袋行PVP可明显降低骨水泥椎体外渗漏率，更好地恢复椎体高度，在疼痛缓解与活动能力改善方面与传统PVP相似。

英文摘要:

  【Abstract】 Objectives: To explore the clinical outcomes of Bone Filling Mesh Container(BFMCs) in the treatment of thoracolumbar osteolytic metastases. Methods: A total of 48 cases(77 vertebral bodies) with thoracolumbar osteolytic metastases were applied with PVP from October 2012 to October 2016, in whom 23 cases with 37 vertebral bodies were performed traditional PVP(TPVP group), and 25 cases with 40 vertebral bodies were performed PVP by using bone filling mesh container(BFMCs group). There was no statistical difference in age, sex ratio and vertebral body distribution between the patients in two groups. The bone cement leakage was observed by the "C" arm fluoroscopy during surgery. The VAS score was used to assess the pain relief in the patients on the third day after operation. The Oswestry disability index(ODI) was used to assess the improvement of the activity ability. The reduction extent of the vertebral height was measured in X-ray and CT before discharge. Results: All patients were successfully operated, the success rate of puncture was 100%. There was no pulmonary embolism, paraplegia or perioperative death. In the TPVP group, bone cement leakage occurred in 18 vertebrae(48.6%, 18/37), but these patients had no clinical symptoms. There was no case of bone cement leakage in BFMCs group. All patients had pain relief within three days after surgery. The VAS score of TPVP group was decreased from 7.8±1.3(5-10) preoperatively to 2.4±1.4(1-4) postoperatively, and the VAS score of BFMCs group was decreased from 7.9±1.1(6-10) to 2.5±1.3(1-4). ODI score of TPVP group decreased from (73.4±4.6)% preoperatively to (23.6±4.3)% postoperatively, BFMCs group decreased from (74.6±4.9)% to (23.9±4.5)%. The VAS score and ODI of the two groups after operation were significantly different from those before operation(P<0.05), and there was no significant difference between the two groups preoperatively and postoperatively. Postoperatively, increasing ratio of anterior vertebral body was (3.2±2.6)% in the TPVP and (11.8±11.6)% in the BFMCs group. Increasing ratio of middle vertebral body was (5.4±4.1)% in the TPVP group and (22.1±14.7)% in the BFMCs group, there was significant difference between two groups(P<0.05). Conclusions: In the patients with osteolytic metastases in thoracolumbar spine, bone filling mesh container can significantly reduce the leakage rate of bone cement in PVP, and better restore the height of vertebral body. There was no significant difference in pain relief and activity improvement with TPVP.