单纯椎板减压椎弓根螺钉内固定术与联合微波消融治疗脊柱转移瘤的疗效比较

Clinical outcomes of decompression and pedicle screw fixation combined with or without microwave ablation in the treatment of spinal metastases

中文关键词:  脊柱转移瘤  微波消融  椎板减压椎弓根螺钉内固定术  病理性骨折

英文关键词:Spinal metastases  Microwave ablation  Decompression and screw fixation  Pathological fractures

中文摘要:

  【摘要】 目的：比较单纯椎板减压、椎弓根螺钉内固定术与联合应用病灶微波消融术治疗脊柱转移瘤的临床效果。方法：回顾性分析2017年1月~2020年1月四川大学华西医院及四川省第四人民医院收治的69例脊柱转移瘤伴病理性骨折患者的临床资料，男41例，女28例，年龄27~71岁（52.8±9.7岁），单椎体受累43例，两个及以上椎体受累26例。按手术方式分为两组：A组37例采用单纯后路椎板减压、椎弓根螺钉内固定术治疗，B组32例采用病灶微波消融灭活联合椎板减压、椎弓根螺钉内固定术治疗。患者术前行Tomita评分、Tokuhashi评分，并采用硬膜外脊髓压迫（epidural spinal cord compression，ESCC）评分系统评估脊髓压迫程度，脊柱肿瘤不稳定评分系统（spinal instability neoplastic score，SINS）评估脊柱稳定性。记录所有患者术前神经功能障碍时间、手术时间和术中出血量，并于术前及术后随访时记录其脊髓神经功能Frankel分级、疼痛VAS评分和SF-36生活质量评分。通过Kaplan-Meier法评价所有患者的总体生存期和无进展生存期。两组同时间点比较采用独立样本t检验，组内比较采用配对t检验，两组率的比较采用χ2检验。结果：69例患者均获得随访，随访时间为5~36个月，中位时间A、B组分别为18个月和20个月。两组患者的术前Tomita评分、改良Tokuhashi评分、SINS评分和ESCC评分均无明显差异（P＞0.05）。两组患者手术时间无统计学差异（P＞0.05）；A组术中出血量为567±137ml，低于B组的690±90ml（P=0.02）。两组患者VAS评分和SF-36生活质量评分在术后随访时均较术前改善；两组间比较术前和术后24h无统计学差异（P＞0.05）；A组术后1个月和3个月时VAS评分分别为2.84±1.30和2.45±1.01，术后3个月时SF-36评分为67.43±7.49，均优于同时间点B组（P<0.05）。A组有89.2%（33例）、B组有93.8%（30例）的患者在术后脊髓功能得到改善，两组间比较无统计学差异（P＞0.05）。两组总体生存期无明显差异（P＞0.05），B组无进展生存期优于A组（P=0.03）。结论：与单纯椎板减压、椎弓根螺钉内固定术比较，微波消融灭活技术联合后路椎板减压、椎弓根螺钉内固定术治疗脊柱转移瘤伴病理性骨折患者，不增加手术创伤和风险，并在缓解疼痛、提高脊柱稳定性和改善患者生存质量等方面具有一定的优势。

英文摘要:

  【Abstract】 Objectives: Clinical observation and comparison of microwave ablation combined with or without decompression and pedicle screw fixation in the palliative treatment of spinal metastases. Methods: From January 2017 to January 2020, 69 patients with spinal metastases and pathological fractures were treated in West China Hospital and the Fourth Sichuan Provincial People′s Hospital. 37 patients received pedicle screw fixation with laminectomy(group A), and 32 patients received microwave ablation combined with laminectomy and pedicle screw fixation(group B). The Tomita and Tokuhashi scores, preoperative neurological dysfunction time, operation time and intraoperative blood loss of all patients were recorded. The epidural spinal cord compression(ESCC) and spinal instability neoplastic score(SINS) scores were used to evaluate the degree of spinal compression and spinal instability. The Frankel grade of spinal nerve function, VAS pain score, and SF-36 quality of life score were recorded before and after operation. Kaplan-Meier method was used to evaluate the overall survival and progression free survival of all patients. Independent sample t-test was used to compare the two groups at the same time point, paired t-test was used to compare within group, and χ2 test was used to compare the rates of two groups. Results: All the 69 patients were followed up for 5 to 36 months with the median time of 18 and 20 months in two groups, respectively. There was no significant difference in preoperative Tomita scores, modified Tokuhashi scores, SINS scores and ESCC scores between the two groups. The intraoperative blood loss of group A was 567±137ml, which was lower than that of group B 690±90ml(P=0.02). The VAS score and SF-36 quality of life scores of the two groups were improved after operation. There was no difference between the two groups before and 24 hours after operation. The VAS scores of group A were 2.84±1.30 and 2.45±1.01 at 1 and 3 months after operation, and the SF-36 score of group A was 67.43±7.49 at 3 months after operation. The two scores of group A were better than those of group B (P<0.05). 89.2%(33 cases) patients in group A and 93.8%(30 cases) patients in group B improved in the postoperative spinal cord function. There was no significant difference between the two groups. There was no significant difference in the overall survival between the two groups, but the progression free survival in group B was better than that in group A(P=0.03). Conclusions: The microwave ablation combined with decompression and pedicle screw fixation does not significantly increase the surgical trauma and patient risk, and it has a certain comparative advantage and clinical application value in relieving pain, improving vertebral stability, improving patients′ quality of life in the treatment of spinal metastases.