分离手术联合射频消融、骨水泥强化术治疗胸腰椎转移瘤的短期疗效

Short-term efficacy of separation surgery combined with radiofrequency ablation and bone cement reinforcement for thoracolumbar metastatic tumors

中文关键词:  脊柱转移瘤  胸腰椎  分离手术  射频消融  骨水泥强化术  疗效

英文关键词:Spinal metastasis tumor  Thoracolumbar  Seperation surgery  Radiofrequency ablation  Bone cement reinforcement  Efficacy

中文摘要:

  【摘要】 目的：探讨分离手术联合射频消融、骨水泥强化术治疗胸腰椎转移性肿瘤的短期临床效果。方法：回顾性分析2018年1月~2023年6月就诊于宁夏医科大学总医院的93例胸腰椎转移瘤患者的临床资料。根据治疗方式分为A组（32例，男13例，女19例，年龄59.8±10.0岁，采用分离手术联合射频消融及骨水泥强化术治疗）、B组（28例，男16例，女12例，年龄60.5±70.7岁，采用分离手术联合骨水泥强化术治疗）、C组（33例，男12例，女21例，年龄57.5±14.5岁，采用放射治疗）。所有患者均行美国东部肿瘤协作组分级系统（Eastern Cooperative Oncology Group，ECOG）评分、改良Tokuhashi评分、Tomita评分、脊柱肿瘤不稳定评分系统（spinal instability neoplastic score，SINS）评分、硬膜外脊髓压迫分级（epidural spinal cord compression，ESCC）评分，比较不同组间的手术时间、术中出血量，治疗前，治疗后1周、1个月和3个月 Frankel分级、疼痛视觉模拟量表（visual analogue scale，VAS）评分、卡氏功能状态评分系统（Karnofsky performance status，KPS）评分，评估不同治疗方法的临床效果。结果：所有患者均获得随访，随访时间为16.1±5.1个月（6~27个月）。14例患者在随访期间死亡生存时间为14.1±4.6个月（7~24个月）。A、B两组患者手术时间差异无统计学意义（P>0.05），A组术中出血量少于B组，差异有统计学意义（P<0.05）。三组患者治疗前组间VAS评分差异无统计学意义（P>0.05），A组、B组治疗后1周、1个月、3个月时VAS评分明显降低，与C组VAS评分之间差异具有统计学意义（P<0.01），C组术前与术后1周VAS评分之间差异无统计学意义（P>0.05）。三组患者神经功能均有不同程度的恢复，术后1个月及末次随访时A组与B组神经功能情况比较，差异无统计学意义（P>0.05），A组、B组分别与C组比较神经功能恢复差异有统计学意义（P<0.05）。三组患者治疗前KPS评分之间的差异无统计学意义（P>0.05），A组、B组治疗后1周、3个月及末次随访时KPS评分明显升高，A组较B组更明显，与C组KPS评分之间差异具有统计学意义（P<0.05）。结论：分离手术联合射频消融、骨水泥强化术治疗胸腰椎转移性肿瘤，能够明显减轻患者疼痛、改善神经功能、显著增强行为能力，明显改善生活质量。

英文摘要:

  【Abstract】 Objectives: To explore the short-term clinical effectiveness of separation surgery combined with radiofrequency ablation and bone cement reinforcement in the comprehensive treatment of metastatic tumors in thoracolumbar spine. Methods: A retrospective analysis was conducted on the clinical data of 93 patients with thoracolumbar metastatic tumors who were admitted to Ningxia Medical University General Hospital from January 2018 to June 2023. Based on different treatment methods, patients were divided into group A(32 patients, 13 males, 19 females, aged 59.8±10.0 years old, treated with separation surgery combined with radiofrequency ablation and bone cement reinforcement), group B(28 patients, 16 males, 12 females, aged 60.5±70.7 years old, treated with separation surgery combined with bone cement reinforcement), and group C(33 patients, 12 males, 21 females, aged 57.5±14.5 years old, treated with radiotherapy ablation). All the patients were assessed using the Eastern Cooperative Oncology Group(ECOG) score, modified Tokuhashi score, Tomita score, spinal instability neoplastic score(SINS), and epidural spinal compression(ESCC) score. The operative time and intraoperative blood loss were compared between the groups, while the Frankel classification, visual analogue scale(VAS) score, and Karnofsky performance status(KPS) score were assessed before treatment and at 1 week, 1 month, and 3 months after treatment for clinical efficacy analysis. Results: All the patients were followed up for 16.1±5.1(6-27 months). 14 patients died during the follow-up period, with a mean survival time of 14.1±4.6 months(7-24 months). There was no statistically significant difference in operative time between groups A and B(P>0.05), but intraoperative blood loss in group A was significantly lower than in group B(P<0.05). There was no significant difference in baseline VAS scores among the three groups(P>0.05). VAS scores in groups A and B were significantly reduced at 1 week, 1 month, and 3 months after treatment, with significant differences compared to group C(P<0.01). In group C, no significant difference was found in VAS scores pre- and post-treatment(P>0.05). Neurological functions showed varying degrees of recovery across all groups. At 1 month after surgery and final follow-up, there was no significant difference in neurological function between groups A and B(P>0.05), but both groups demonstrated significant differences in neurological recovery compared to group C(P<0.05). KPS scores showed no significant difference among the three groups before treatment(P>0.05). However, KPS scores in groups A and B increased significantly at 1 week, 3 months, and final follow-up after treatment, with group A showing a more pronounced improvement compared to group B(P<0.05). Conclusions: Separation surgery combined with radiofrequency ablation and bone cement reinforcement can significantly alleviate pain, improve neurological recovery, enhance functional ability, and markedly improve quality of life in patients with thoracolumbar metastatic tumors.