经皮椎体成形术治疗肿瘤晚期上胸椎转移瘤的疗效分析

Efficacy analysis of percutaneous vertebroplasty in the treatment of upper thoracic vertebral metastases of advanced-stage tumors

中文关键词:  脊柱转移瘤  上胸椎  椎体成形术

英文关键词:Vertebral metastases  Thoracic vertebrae  Vertebroplasty

中文摘要:

  【摘要】 目的：评价经皮椎体成形术（percutaneous vertebroplasty，PVP）治疗肿瘤晚期上胸椎（T1~T4）转移瘤的疗效和安全性。方法：收集2012年10月~2019年2月在首都医科大学附属北京友谊医院骨科接受PVP治疗的肿瘤晚期上胸椎转移瘤患者的资料，对随访资料完整的45例患者（62个椎体）进行回顾性分析。其中男性19例，女性26例，年龄43~88岁（64.2±13.5岁）。T1椎体4个，T2椎体7个，T3椎体23个，T4椎体28个。术前均处于肿瘤晚期（Tokuhashi修正评分≤8分或Tomita评分≥7分），均合并严重背部疼痛，无脊髓压迫。收集患者手术相关指标、骨水泥渗漏及并发症发生情况，手术前和手术后3d、3个月、6个月视觉模拟量表（visual analogue scale，VAS）评分、镇痛药使用评分和卡氏日常状态评分（Karnofsky performance score，KPS），综合评估患者术后生活质量的改善情况。结果：患者均顺利完成PVP。手术时间25~85min（45.1±13.3min），术中出血量5~30mL（12.8±6.6mL），每节椎体骨水泥注射量为1.5~5mL（2.8±0.7mL）。17例患者的21个椎体发生骨水泥渗漏，骨水泥渗漏率为33.87%（21/62）。未发生严重并发症。术前VAS评分7.9±1.1分，术后3d 3.8±1.5分、术后3个月2.9±0.8分、术后6个月3.0±1.3分；术前镇痛药使用评分3.3±0.8分，术后3d 1.7±0.8分、术后3个月2.8±0.9分、术后6个月1.4±0.9分，术后各时间点的VAS评分和镇痛药使用评分与术前比较均有显著性改善（P＜0.05）。术前KPS评分52.7±10.1分，术后3d 62.6±8.2分，术后3个月64.9±8.9分，术后6个月59.1±17.0分，术后3d和3个月与术前比较均有显著性升高（P<0.001），术后6个月与术前比较无显著性差异（P=0.135）。结论：对于预期生存时间较短的肿瘤晚期上胸椎转移瘤患者，PVP可以有效缓解患者背部疼痛症状，术后早期生活质量改善明显，但骨水泥渗漏率较高，需引起重视。

英文摘要:

  【Abstract】 Objectives: To evaluate the efficacy and safety of percutaneous vertebroplasty(PVP) in the treatment of upper thoracic spine(T1-T4) metastases in patients with advanced-stage tumors. Methods: Data were collected from patients with advanced-stage upper thoracic spine metastases who underwent PVP at the Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, from October 2012 to February 2019. A retrospective analysis was conducted on 45 patients(62 vertebrae) with complete follow-up data. Among them, there were 19 males and 26 females, aged 43-88 years(64.2±13.5 years). The affected vertebrae included 4 T1 vertebrae, 7 T2 vertebrae, 23 T3 vertebrae, and 28 T4 vertebrae. All the patients were in the advanced stage of cancer(Tokuhashi revised score ≤8 or Tomita score ≥7), presented with severe back pain, without spinal cord compression. The operation related parameters, bone cement leakage, and complications were collected. Preoperative and postoperative(3d, 3 months, and 6 months) visual analogue scale(VAS) scores, analgesic usage scores, and Karnofsky performance scores(KPS) were collected to comprehensively evaluate improvements in postoperative quality of life. Results: All patients successfully completed the PVP procedure. The operation time ranged from 25 to 85mins (45.1±13.3mins), intraoperative blood loss ranged from 5 to 30mL(12.8±6.6mL), and bone cement injection volume per vertebra ranged from 1.5 to 5mL(2.8±0.7mL). Cement leakage occurred in 21 vertebrae of 17 patients, with a leakage rate of 33.87%(21/62). No severe complications were observed. Preoperative VAS score was 7.9±1.1, postoperative 3d score was 3.8±1.5 points, postoperative 3 months was 2.9±0.8 points, and postoperative 6 months was 3.0±1.3 points. The preoperative analgesic usage score was 3.3±0.8 points, the postoperative 3d score was 1.7±0.8 points, the postoperative 3-month score was 2.8±0.9 points, and the postoperative 6-month score was 1.4±0.9 points. VAS and analgesic usage scores at all postoperative time points showed significant improvement compared to preoperative scores(P<0.05). Preoperative KPS score was 52.7±10.1 points, postoperative 3d score was 62.6±8.2 points, postoperative 3 months was 64.9±8.9 points, and postoperative 6 months was 59.1±17.0 points. There was a significant increase in postoperative 3d and 3 months′ KPS scores compared to preoperative value(P<0.001), while there was no significant difference in postoperative 6 months′s score compared to preoperative value(P=0.135). Conclusions: For patients with advanced-stage upper thoracic spine metastases and limited life expectancy, PVP effectively alleviates back pain and significantly improves early postoperative quality of life. However, the relatively high rate of cement leakage warrants attention.