| 姚珍松,李文超,梁 德,张顺聪,任 辉,唐晶晶.经皮椎体成形术联合射频消融治疗脊柱转移瘤的临床疗效及术后预后的影响因素分析[J].,2022,(2):304-309 |
| 经皮椎体成形术联合射频消融治疗脊柱转移瘤的临床疗效及术后预后的影响因素分析 |
| Clinical Efficacy and Postoperative Prognostic Influencing Factors Analysis of Percutaneous Vertebroplasty Combined with Radiofrequency Ablation in the Treatment of Spinal Metastases |
| 投稿时间：2021-06-13 修订日期：2021-07-10 |
| DOI：10.13241/j.cnki.pmb.2022.02.020 |
| 中文关键词: 经皮椎体成形术 射频消融 脊柱转移瘤 临床疗效 术后预后 影响因素 |
| 英文关键词: Percutaneous vertebroplasty Radiofrequency ablation Spinal metastases Clinical efficacy Postoperative prognostic Influence factor |
| 基金项目:卫生部医药卫生科技发展研究中心资助项目（W2014ZT256）；广州中医药大学第一附属医院高水平手术重点建设项目（2019ZD04） |
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| 中文摘要: |
| 摘要 目的：观察经皮椎体成形术（PVP）联合射频消融（RFA）治疗脊柱转移瘤的临床疗效，并分析术后预后的影响因素。方法：回顾性分析2016年5月~2019年5月期间广州中医药大学第一附属医院和广州中医药大学第三附属医院的60例脊柱转移瘤患者的临床资料。在60例患者中，行PVP治疗的患者28例纳为PVP组，行PVP联合RFA治疗的患者32例纳为联合组。术前、术后6个月采用视觉疼痛模拟评分（VAS）、ODI指数、卡式功能（KPS）评分评价患者的疼痛、运动功能、生活质量。统计患者生存情况，对脊柱转移瘤患者的术后预后进行单因素分析，并进行COX多因素分析，观察影响预后的危险因素。结果：联合组术后6个月VAS、ODI评分低于PVP组，KPS评分高于PVP组（P<0.05）。联合组骨水泥总外渗率、术后6个月肿瘤复发率均低于PVP组（P<0.05）。Kaplan-Meier生存曲线显示，两组术后生存率比较无显著性差异（P>0.05），两组随访患者术后生存时间基本一致。经单因素分析表明，术后局部放疗、脊柱外骨转移、内脏转移、原发肿瘤性质及确诊至转移时间在两组间的对比，差异有统计学意义（P<0.05）。COX回归模型分析结果显示影响脊柱转移瘤患者术后预后的危险因素包括确诊至转移时间≤20个月、术后无局部放疗、原发肿瘤进展迅速、脊柱外骨转移、有内脏转移（P<0.05）。结论：PVP联合RFA治疗脊柱转移瘤患者，可有效提高患者运动功能及生活质量，减轻疼痛。但其术后预后受多种因素影响，需采取针对性预防措施。 |
| 英文摘要: |
| ABSTRACT Objective: To observe the clinical efficacy of percutaneous vertebroplasty (PVP) combined with radiofrequency ablation (RFA) in the treatment of spinal metastases, and to analyze the postoperative prognostic influencing factors. Methods: The clinical data of 60 patients with spinal metastases in the The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine and the The Third Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from May 2016 to May 2019 were retrospectively analyzed. Among the 60 patients, 28 patients receiving PVP treatment were enrolled in the PVP group, and 32 patients receiving PVP combined with RFA were enrolled in the combined group. Visual pain analog scale (VAS), ODI index and card function (KPS) score were used to evaluate the pain, motor function and quality of life of the patients before operation and 6 months after operation. The survival of patients was counted, the postoperative prognostic of patients with spinal metastases was analyzed by univariate analysis, and Cox multivariate analysis, and the risk factors affecting prognosis were observed. Results: 6 months after operation, the VAS and ODI scores of the combined group were lower than those of the PVP group, and the KPS score was higher than that of the PVP group(P<0.05). The total extravasation rate of bone cement and tumor recurrence rate at 6 months after operation of the combined group were lower than those of the PVP group(P<0.05). Kaplan-Meier survival curve showed that there was no significant difference in the postoperative survival rate between the two groups (P>0.05), and the postoperative survival time of patients in the two groups was basically the same. Univariate analysis showed that there were statistically significant differences between the two groups in postoperative local radiotherapy, extraspinal bone metastasis, visceral metastasis, primary tumor nature and time from diagnosis to metastasis(P<0.05). The results of COX regression model showed that the main risk factors affecting the postoperative prognosis of patients with time from diagnosis to metastasis ≤20 months, there were no local radiotherapy, rapid progression of primary tumor, extraspinal bone metastasis, visceral metastasis(P<0.05). Conclusion: PVP combined with RFA in the treatment of patients with spinal metastatic tumor can effectively improve the patients' motor function and quality of life, and relieve pain. However, the postoperative prognosis is affected by many factors, and targeted preventive measures should be taken. |
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