摘要
目的探讨立体定向放疗联合经皮椎弓根螺钉置入(PPS)及经皮椎体成形术(PVP)与联合分离手术治疗胸腰椎脊柱转移瘤的临床疗效。方法回顾性选取2016年5月至2021年5月在解放军总医院第五医学中心接受择期手术治疗的83例脊柱转移瘤患者的临床资料。根据手术方式分为A组(立体定向放疗联合PPS+PVP,37例)和B组(立体定向放疗联合分离手术,46例)。比较两组患者在不同时间点疼痛、椎体功能、神经功能和生活质量的情况,同时分析两组患者术后3年的生存率和总生存期。结果两组患者视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、Frankel神经功能评分和Karnofsky功能状态评分(KPS)随时间变化而不同(P<0.05);A组VAS评分在术后1周、1个月、3个月和6个月均低于B组(P<0.05);A组ODI评分在术后6个月和12个月均高于B组,Frankel神经功能评分则低于B组(P<0.05);在不同时间点,两组患者KPS评分比较,差异无统计学意义(P>0.05)。两组患者3年生存率、总生存期、随访期间的肿瘤复发率和转移率比较,差异无统计学意义(P>0.05)。结论立体定向放疗联合分离手术治疗有助于促进椎体功能的恢复、减轻脊髓神经压迫,其效果优于立体定向放疗联合PPS+PVP术,但接受分离手术的患者疼痛缓解情况较差。
Objective To investigate the clinical effects of stereotactic radiotherapy combined with percutaneous pedicle screw(PPS)+percutaneous vertebraplasty(PVP)or separation surgery in the treatment of thoracolumbar spinal metastases.Methods This study retrospectively analyzed the clinical data of 83 patients with thoracolumbar spinal metastases who underwent elective surgical treatment at the 5th Medical Center of PLA General Hospital between May 2016 and May 2021.Patients were divided into group A(stereotactic radiotherapy combined with PPS+PVP,37 patients)and group B(stereotactic radiotherapy combined with separation surgery,46 patients)based on different surgical methods.Pain,vertebral function recovery,neurological function,and quality of life were compared between the two groups at multiple time points.There-year survival rates and overall survival were also analyzed.Results The visual analogue scale(VAS)scores,Oswestry disability index(ODI)scores,Frankel neurological function scores,and Karnofsky performance status(KPS)scores differed between the two groups at different time points(P<0.05).Group A had significantly lower VAS scores than group B at 1 week,1 month,3 months,and 6 months postoperatively(P<0.05).Group A had significantly higher ODI scores and significantly lower Frankel neurological function scores than group B at 6 and 12 months postoperatively(P<0.05).The KPS scores showed no significant differences between the two groups at all time points(P>0.05).There were no significant differences in the 3-year survival rate,overall survival,tumor recurrence rate,or metastasis rate during follow-up between the two groups(P>0.05).Conclusion Stereotactic radiotherapy combined with separation surgery achieves better effects than stereotactic radiotherapy combined with PPS+PVP in promoting vertebral function recovery and in relieving spinal nerve compression.However,separation surgery is inferior for pain relief.
作者
江宁
郭钧
刘铖
郭玮
郝志亚
JIANG Ning;GUO Jun;LIU Cheng;GUO Wei;HAO Zhiya(Department of Orthopedics,the 5th Medical Center of PLA General Hospital,Beijing 100070,China;Department of Orthopedics,the First Hospital of Tsinghua University,Beijing 100016,China)
出处
《转化医学杂志》
2025年第6期1-6,共6页
Translational Medicine Journal
基金
国家自然科学基金(3167080224)。
