张超, 王国文, 韩秀鑫, 滕胜, 马育林, 多健, 杨吉龙. 椎板减压联合射频消融辅助椎体成形术治疗高度恶性肿瘤脊柱转移的临床研究[J]. 中国肿瘤临床, 2014, 41(9): 585-588. DOI: 10.3969/j.issn.1000-8179.20130911
引用本文: 张超, 王国文, 韩秀鑫, 滕胜, 马育林, 多健, 杨吉龙. 椎板减压联合射频消融辅助椎体成形术治疗高度恶性肿瘤脊柱转移的临床研究[J]. 中国肿瘤临床, 2014, 41(9): 585-588. DOI: 10.3969/j.issn.1000-8179.20130911
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ZHANG Chao, WANG Guowen, HAN Xiuxin, TENG Sheng, MA Yulin, DUO Jian, YANG Jilong. Posterior laminectomy and vertebroplasty combined with radiofrequency ablation in spinal metastases from malignant tumors[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2014, 41(9): 585-588. DOI: 10.3969/j.issn.1000-8179.20130911
Citation: ZHANG Chao, WANG Guowen, HAN Xiuxin, TENG Sheng, MA Yulin, DUO Jian, YANG Jilong. Posterior laminectomy and vertebroplasty combined with radiofrequency ablation in spinal metastases from malignant tumors[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2014, 41(9): 585-588. DOI: 10.3969/j.issn.1000-8179.20130911
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椎板减压联合射频消融辅助椎体成形术治疗高度恶性肿瘤脊柱转移的临床研究

Posterior laminectomy and vertebroplasty combined with radiofrequency ablation in spinal metastases from malignant tumors

    摘要
  • 摘要:
      目的  探讨高度恶性肿瘤脊柱转移患者进行椎板减压联合射频消融辅助椎体成形术的安全性和有效性。
      方法  回顾性分析2008年6月至2012年5月高度恶性肿瘤脊柱转移患者23例（肺癌13例，肝癌5例，胃癌3例，结肠癌2例），其中男性13例，女性10例，年龄40~65岁，平均为51.5岁。术中先行后路椎板减压，在开放手术下对病变椎体射频消融后行椎体成形术，所有患者均行脊柱内固定，记录手术时间及术中出血量，统计骨水泥渗漏率。于术前、术后1个月，应用视觉模拟评分（visual analogue scale，VAS）评估疼痛、Frankel分级评估脊髓损伤、卡氏（Karnofsky，KPS）评分系统评估功能状态、统计“二便”恢复情况，应用EORTC QLQ-C30评分评估生活质量。
      结果  手术时间平均为163±87.36 min，术中出血量平均为430.00±130.35 mL，骨水泥渗漏率为21.7%。术后一个月疼痛（VAS评分）较术前明显缓解，具有统计学意义（t=25.6，P < 0.01）；术后1个月，患者Frankel分级D、E级比例由术前的43.5%提高到术后的78.3%；KPS评分（80~100）百分比由术前的34.8%提高到术后的69.6%；术前“二便”障碍的患者术后有55.6%（10/18）得到不同程度缓解。术前EORTC QLQ-C30评分为85.39±8.99分，术后为52.78±15.17分，患者生活质量明显提高（t=11.6，P < 0.01）。
      结论  椎板减压联合射频消融辅助椎体成形术治疗高度恶性肿瘤脊柱转移手术时间短、出血量少、骨水泥渗漏率低，能够明显减轻患者疼痛、改善脊髓损伤和功能状态，部分患者“二便”功能得以恢复，生存质量得到明显提高。

     

    Abstract:
      Objective  To investigate the safety and efficacy of laminectomy combined with vertebroplasty in spinal metastases from rapid-growth tumors.
      Methods  Clinical data of 23 patients with spinal metastases of lung cancer, who were admitted to the Cancer Hospital from July 2008 to May 2012, were retrospectively analyzed. Thirteen male and ten female patients, with an age range from 40 years to 65 years and a mean age of 51.5, were examined. All patients received posterior laminectomy to relieve spinal cord compression. Afterward, vertebroplasty combined with radiofrequency ablation was conducted, followed by the internal fixation of vertebrae (instrumental fixation). Operation time, blood loss, and bone cement leakage rate were analyzed. One month before and after the operation, pain measurement was conducted using visual analog scale (VAS) and neurologic deficit (spinal cord injury) by Frankel Grade. Functional impairment was classified by Karnofsky performance status (KPS) score. Quality of life was assessed by the European Organization for Research and Treatment questionnaire (EORTC QLQ-C30).
      Results  The mean operation time was 163±87.36 min. Blood boss was 430±130.35 mL. Bone cement leakage rate was 21.7%. One month before and after surgery, the VAS showed statistical significance (t=25.6, P < 0.01). After surgery, 78.3% of all patients exhibited functionally satisfactory Frankel Grade D or E, compared with 43.5% of patients before the operation. KPS score (80 to 100) percentage was 69.6% after surgery compared with 34.8% before surgery. One month after the operation, remission of various degrees was seen in 10 of 18 patients who had sphincteric dysfunction before surgery (55.6%). The EORTC QLQ-C30 score was 85.39±8.99 before and 52.78±15.17 after operation. The quality of life improved significantly (t=11.6, P < 0.01).
      Conclusion  Posterior laminectomy and vertebroplasty combined with radiofrequency ablation for spinal metastases from lung cancer is safe and effective. The treatment can improve pain, function, and life quality of patients with lung cancer spinal metastases.

     

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