复合式冷热消融联合椎体成形术治疗脊柱转移瘤的疗效分析

Efficacy analysis of co-ablation system combined with vertebroplasty for spinal metastases

中文关键词:  脊柱转移瘤  复合式冷热消融  椎体成形术  全椎体切除术

英文关键词:Spinal metastases  Co-ablation system  Vertebroplasty  Total en bloc spondylectomy

中文摘要:

  【摘要】 目的：探讨复合式冷热消融联合椎体成形术治疗脊柱转移瘤的临床疗效。方法：回顾性分析2015年9月~2023年9月西安交通大学附属红会医院收治的45例符合纳入标准的脊柱转移瘤患者，其中20例患者采用椎板减压联合复合式冷热消融及椎体成形术[观察组，男12例，女8例；年龄16~72岁（51.5±14.4岁）；胸椎7例，腰椎13例]；25例患者采用全椎体切除术（total en bloc spondylectomy，TES）[对照组，男14例，女11例；年龄26~72岁（53.7±13.8岁）；胸椎11例，腰椎14例]。两组患者的年龄、性别比、转移部位、原发肿瘤部位、硬膜外脊髓压迫（epidural spinal cord compression，ESCC）评分、脊柱肿瘤不稳定评分系统（spine instability neoplastic system，SINS）评分、Tomita评分和神经功能Frankel分级均无统计学差异（P＞0.05）。记录两组患者手术时间、术中出血量和接受进一步放化疗或者靶向治疗的时间，所有患者术前和术后3d、1个月、6个月使用疼痛视觉模拟量表（visual analogue scale，VAS）评分、欧洲癌症研究与治疗组织的骨转移瘤患者生存质量量表（quality of life questionnaire bone metastases module，QLQ-BM22）评分和Frankel分级分别对患者疼痛程度、生活质量得分情况及脊髓神经功能情况进行评估，随访患者局部肿瘤进展情况。结果：所有患者手术均顺利完成，观察组手术时间（122.5±22.0min）和术中出血量（225.0±58.3mL）显著性少于对照组（217.6±17.4min和1064.0±131.1mL）（P＜0.05）。两组患者术后3d、1个月、6个月的VAS评分及QLQ-BM22评分均显著性低于术前（P＜0.05）；观察组术后3d、1个月时的VAS评分、QLQ-BM22评分均低于对照组，差异有统计学意义（P＜0.05）；术后6个月两组VAS评分及QLQ-BM22评分均无统计学差异（P＞0.05）；观察组术后接受进一步放化疗或者靶向治疗的时间为5.10±1.17d，对照组为10.84±1.82d，差异有统计学意义（P＜0.05）；观察组术后6个月局部肿瘤进展率为10%（2/20），对照组为12%（3/25），差异无统计学意义（P＞0.05）。结论：采用复合式冷热消融联合椎体成形术治疗脊柱转移瘤能够早期达到传统TES手术疗效，同时减少了手术创伤及术后治疗中断或延迟，安全有效。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical efficacy of co-ablation combined with vertebroplasty for spinal metastases. Methods: 45 patients with spinal metastases admitted and treated in the Honghui Hospital, Xi′an Jiaotong University from September 2015 to September 2023 and met the inclusion criteria were analyzed retrospectively. 20 patients underwent co-ablation combined with vertebroplasty following decompressive laminectomy[Study group, 12 males and 8 females, 51.5±14.4(16-72) years; Thoracic spine 7 cases, lumbar spine 13 cases]; 25 patients underwent total en bloc spondylectomy[Control group, 14 males and 11 females, 53.7±13.8(26-72) years; Thoracic spine 11 cases, lumbar spine 14 cases]. There were no significant differences in the baseline data, such as age, gender ratio, affected segment, the site of primary tumor, the grades of epidural spinal cord compression(ESCC), spine instability neoplastic system(SINS) score, Tomita score and Frankel grades between the two groups(P>0.05). The operative time, intraoperative blood loss, and the time of receiving further chemoradiotherapy or targeted therapy were collected and analyzed. The visual analogue scale(VAS) score, European Organization for Research and Treatment of Cancer(EORTC) quality of life questionnaire bone metastases module(QLQ-BM22) score and Frankel grades were used to evaluate the degree of pain relief, the changes of quality of life, and the improvement of spinal nerve function before treatment and at 3d, 1 month and 6 months. The patients underwent enhanced CT or MRI examinations during follow-up period to observe local tumor progression. Results: All the patients in this study successfully underwent surgery. The operative time and intraoperative blood loss in study group(122.5±22.0min and 225.0±58.3mL) were significantly less than the value(217.6±7.4min and 1064.0±131.12mL) in control group(P<0.05). The VAS score and QLQ-BM22 score of the two groups at 3d, 1 month and 6 months after operation were significantly lower than those before operation, and the difference were statistically significant(P<0.05); The VAS score and QLQ-BM22 score of the study group at 3d and 1 month after operation were significantly lower than those in the control group(P<0.05); No statistically significant differences in VAS score and QLQ-BM22 score at 6 months after operation were found between the two groups(P>0.05); The study group received further chemoradiotherapy or targeted therapy for 5.10±1.17d after operation, while that in the control group was 10.84±1.82d, and the difference was statistically significant(P<0.05); The postoperative 6-month local tumor progression rate was 10%(2/20) in the study group and 12%(3/25) in the control group, with no statistically significant difference between the two groups(P＞0.05). Conclusions: The co-ablation system combined with vertebroplasty can successfully obtained a curative effect parallel to traditional total en bloc spondylectomy in short-term, while significantly reducing surgical trauma and minimizing any potential postoperative treatment interruptions or delays. This approach in treating patients with spinal metastases is both safe and effective.