摘要
目的探讨骨填充网袋(bone-filling mesh containers,BFMCs)经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗椎体后方破裂的脊柱转移瘤的疗效及安全性。方法采用回顾性队列研究。收集2022年12月~2024年5月48例溶骨性脊柱转移瘤患者的临床资料。48例病人共51个椎体行单纯PVP术和网袋PVP手术治疗,其中A组25例26个椎体行单纯PVP手术,B组23例25个椎体行网袋PVP手术治疗。比较两组的骨水泥注入量、术后病椎增加高度、术后1年病椎丢失高度、术后24 h及术后3个月疼痛视觉模拟评分(visual analogue scale,VAS)的改善率及骨水泥渗漏的发生率。结果PVP手术组术中骨水泥注入量为(3.7±0.3)mL,术后24 h VAS改善率为73%±5%,术后3个月VAS的改善率为60%±7%;网袋PVP手术组术中骨水泥注入量为(3.4±0.8)mL,术后24 h VAS改善率为71%±7%,术后3个月VAS改善率为62%±4%,组间比较无统计学差异(P>0.05)。PVP手术组术后病椎高度增加(3.9±2.5)mm,术后1年病椎高度丢失(2.0±0.4)mm;网袋PVP手术组术后病椎高度增加(7.4±2.1)mm,术后1年病椎丢失高度为(1.1±0.6)mm,组间比较有统计学差异(P<0.05)。PVP手术组有6个(23.1%)椎体术中出现骨水泥渗漏,其中椎体间隙渗漏1个,椎旁渗漏2个,椎体后缘渗漏3个;网袋PVP手术组仅1个(4%)椎体出现骨水泥渗漏,为椎旁渗漏。两组患者的骨水泥渗漏率比较无统计学差异(P>0.05),且渗漏均未导致神经压迫症状。结论网袋PVP手术治疗椎体后方破裂的脊柱转移瘤有效而安全。推注同等剂量的骨水泥,网袋PVP手术能达到单纯PVP手术同等的止痛效果,且网袋PVP手术对椎体高度的抬升和长期效果的维持均优于单纯PVP手术,骨水泥渗漏的发生率也较低。
Objective To evaluate the efficacy and safety of percutaneous vertebroplasty(PVP)combined with bone-filling mesh containers(BFMCs)in treating spinal metastases with posterior vertebral wall breach.Methods Between December 2022 and May 2024,a total of 48 patients with osteolytic spinal metastases involving 51 vertebrae underwent either conventional PVP or PVP combined with BFMCs.Among them,25 patients(26 vertebrae)in Group A received conventional PVP,while 23 patients(25 vertebrae)in Group B underwent PVP combined with BFMCs.A comparison was made between the two groups regarding the volume of bone cement injected,the postoperative increase in vertebral height,the loss of vertebral height at one year postoperatively,the improvement rate in 24-hour and 3-month postoperative pain visual analogue scale(VAS),and the bone cement leakage rate.Results In Group A,the intraoperative bone cement injection volume was(3.7±0.3)mL,the improvement rate in 24-hour postoperative VAS was 73%±5%,and the 3-month postoperative improvement rate was 60%±7%.In Group B,the intraoperative bone cement injection vol-ume was(3.4±0.8)mL,the improvement rate of 24-hour postoperative VAS was 71%±7%,and the 3-month postoperative VAS improvement rate was 62%±4%.There was no difference between the two groups(P>0.05).The postoperative increase in vertebral height was(3.9±2.5)mm in Group A,with a loss of one-year postoperative vertebral height of(2.0±0.4)mm.In Group B,the postoperative increase in vertebral height was(7.4±2.1)mm,with a loss of one-year postoperative vertebral height of(1.1±0.6)mm.There were significant differences between the two groups(P<0.05).In Group A,bone cement leakage occurred in 6 vertebrae(23.1%),in which one in the intervertebral space,two in the paravertebral region,and three at the posterior vertebral edge.In Group B,bone cement leakage occurred only in one vertebra(4%),which was in the paravertebral region.There was no difference between the two groups(P>0.05),and none of the leakage cases in either group resulted in neurological compression symptoms.Conclusions PVP combined with BFMCs is an effective and safe treatment for spinal metastases with posterior vertebral wall breach.Compared to conventional PVP,it achieves comparable pain relief with the same cement volume while providing superior vertebral height restoration and long-term maintenance,along with a low risk of cement leakage.
作者
武文
樊靖
余一品
李泳
WU Wen;FAN Jing;YU Yipin;LI Yong(Department of Spinal Surgery,the Second People's Hospital of Hunan Province,Changsha 410007,Hunan,China;Department of Thyroid Surgery,Liuzhou People’s Hospital,Liuzhou 545005,Guangxi,China)
出处
《中国现代手术学杂志》
2025年第3期200-204,共5页
Chinese Journal of Modern Operative Surgery
关键词
经皮椎体成形术
脊柱转移瘤
骨填充网袋
percutaneous vertebroplasty
spinal metastases
bone-filling mesh containers
