不同黏度骨水泥椎体成形治疗胸腰椎转移肿瘤
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摘要
背景:经皮穿刺骨水泥椎体成形治疗恶性肿瘤胸腰椎转移的骨水泥渗漏等并发症较为常见,不同填充材料的选择成为影响手术疗效的重要因素。目的:探讨不同黏度骨水泥椎体成形治疗胸腰椎转移瘤的临床疗效。方法:纳入2012年6月至2017年10月武汉市第五医院收治的恶性肿瘤脊柱骨转移患者101例,年龄52-87岁,采取随机分配的方法分2组进行骨水泥椎体成形治疗,观察组(n=49,103椎)应用Confidence高黏度骨水泥,对照组(n=52,107椎)应用贺利氏低黏度骨水泥。治疗后48 h内影像学观察骨水泥渗漏情况;治疗前、治疗后48 h及治疗末次随访时,对比两组疼痛、临床功能与病椎前缘高度、椎体后凸角变化;统计邻近椎体骨折情况。研究通过武汉市第五医院伦理委员会审核批准。结果与结论:(1)两组治疗后的疼痛情况、临床功能均较治疗前明显改善(P <0.05),治疗后相同时间点两组间疼痛情况、临床功能比较差异无显著性意义(P> 0.05);(2)两组治疗后的病椎前缘高度、椎体后凸角均较治疗前明显改善(P<0.05),观察组治疗后不同时间点的病椎前缘高度、椎体后凸角改善程度优于对照组(P<0.05);(3)观察组骨水泥渗漏率低于对照组(16.50%,22.43%,P <0.05),随访期复查无邻近椎体再发骨折、无肺栓塞等严重并发症;(4)结果表明,高、低黏度骨水泥椎体成形治疗胸腰椎转移瘤均可缓解患者疼痛、改善患者生活质量,临床疗效确切、安全性高,其中高黏度骨水泥椎体成形能够更好地恢复椎体前缘高度、降低椎体后凸角、降低骨水泥渗漏风险。
BACKGROUND: Complications such as bone cement leakage are more common in percutaneous vertebroplasty. The choice of different filling materials has become an important factor affecting the surgical outcome.OBJECTIVE: To investigate the clinical efficacy of percutaneous vertebroplasty with different viscosities of bone cement for treatment of thoracolumbar metastases.METHODS: A total of 101 patients with bone metastases of malignant tumors, aged 52-87 years, who were admitted during June 2012 to October 2017 by Fifth Hospital in Wuhan, China were randomly assigned to undergo percutaneous vertebroplasty with Confidence high-viscosity bone cement(observation group, n=49, 103 vertebrae) or Heraeus low-viscosity bone cement(control group, n=52, 107 vertebrae). Within 48 hours after surgery, bone cement leakage was observed by imaging examination. The pain, clinical function and the height of the anterior border of the vertebral body as well as the kyphosis of the vertebral body were compared before surgery, 48 hours after surgery, and at the last follow-up. Adjacent vertebral fractures were statistically analyzed. This study was approved by the Ethics Committee of the Fifth Hospital in Wuhan.RESULTS AND CONCLUSION: After surgery, the pain and clinical function of patients in the two groups were significantly improved compared with those before surgery(P < 0.05). There was no significant difference in pain and clinical function between the two groups at the same time point after surgery(P > 0.05). The height of the anterior border of the vertebral body and the degree of kyphosis of the vertebral body were significantly increased after surgery(P < 0.05). At different time points after surgery, the height of the anterior border of the vertebral body and the degree of kyphosis of the vertebral body were more obviously increased in the experimental group than in the control group(P < 0.05). Bone cement leakage rate in the observation group was significantly lower than that in the control group(16.50% vs. 22.43%,P < 0.05). There were no serious complications, such as recurrent fracture of adjacent vertebral bodies and pulmonary embolism, during the follow up period. These results suggest that high-and low-viscosity bone cement percutaneous vertebroplasty for treatment of thoracolumbar metastases can alleviate pain and improve quality of life with exact clinical efficacy and high safety. High-viscosity bone cement percutaneous vertebroplasty better recovers the height of the anterior border of the vertebral body, reduces the Cobb angles of kyphosis of the vertebral body, and lowers the risk of bone cement leakage than low-viscosity bone cement percutaneous vertesroplasty.
BACKGROUND: Complications such as bone cement leakage are more common in percutaneous vertebroplasty. The choice of different filling materials has become an important factor affecting the surgical outcome.OBJECTIVE: To investigate the clinical efficacy of percutaneous vertebroplasty with different viscosities of bone cement for treatment of thoracolumbar metastases.METHODS: A total of 101 patients with bone metastases of malignant tumors, aged 52-87 years, who were admitted during June 2012 to October 2017 by Fifth Hospital in Wuhan, China were randomly assigned to undergo percutaneous vertebroplasty with Confidence high-viscosity bone cement(observation group, n=49, 103 vertebrae) or Heraeus low-viscosity bone cement(control group, n=52, 107 vertebrae). Within 48 hours after surgery, bone cement leakage was observed by imaging examination. The pain, clinical function and the height of the anterior border of the vertebral body as well as the kyphosis of the vertebral body were compared before surgery, 48 hours after surgery, and at the last follow-up. Adjacent vertebral fractures were statistically analyzed. This study was approved by the Ethics Committee of the Fifth Hospital in Wuhan.RESULTS AND CONCLUSION: After surgery, the pain and clinical function of patients in the two groups were significantly improved compared with those before surgery(P < 0.05). There was no significant difference in pain and clinical function between the two groups at the same time point after surgery(P > 0.05). The height of the anterior border of the vertebral body and the degree of kyphosis of the vertebral body were significantly increased after surgery(P < 0.05). At different time points after surgery, the height of the anterior border of the vertebral body and the degree of kyphosis of the vertebral body were more obviously increased in the experimental group than in the control group(P < 0.05). Bone cement leakage rate in the observation group was significantly lower than that in the control group(16.50% vs. 22.43%,P < 0.05). There were no serious complications, such as recurrent fracture of adjacent vertebral bodies and pulmonary embolism, during the follow up period. These results suggest that high-and low-viscosity bone cement percutaneous vertebroplasty for treatment of thoracolumbar metastases can alleviate pain and improve quality of life with exact clinical efficacy and high safety. High-viscosity bone cement percutaneous vertebroplasty better recovers the height of the anterior border of the vertebral body, reduces the Cobb angles of kyphosis of the vertebral body, and lowers the risk of bone cement leakage than low-viscosity bone cement percutaneous vertesroplasty.
引文
[1]Li Y,Qing Y,Zhang Z,et al.Clinical efficacy of percutaneous vertebroplasty combined with intensity-modulated radiotherapy for spinal metastases in patients with NSCLC.Onco Targets Ther.2015;8:2139-2145.
[2]Yang Z,Tan J,Zhao R,et al.Clinical Investigations on the Spinal Osteoblastic Metastasis Treated by Combination of Percutaneous Vertebroplasty and 125I Seeds Implantation Versus Radiotherapy.Cancer Biother Radiopharm.2013;28(1):58-64.
[3]Mansoorinasab M,Abdolhoseinpour H.A review and update of vertebral fractures due to metastatic tumors of various sites to the spine:Percutaneous vertebroplasty.Interv Med Appl Sci.2018;10(1):1-6.
[4]Liu Y,Wang Y,Zhao L,et al.Effectiveness and safety of percutaneous vertebroplasty in the treatment of spinal metastatic tumor.Pak J Med Sci.2017;33(3):675-679.
[5]Gu YF,Tian QH,Li YD,et al.Percutaneous vertebroplasty and interventional tumor removal for malignant vertebral compression fractures and/or spinal metastatic tumor with epidural involvement:a prospective pilot study.J Pain Res.2017;10:211-218.
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[11]Masala S,Anselmetti GC,Muto M,et al.Percutaneous Vertebroplasty Relieves Pain in Metastatic Cervical Fractures.Clin Orthop Relat Res.2011;469(3):715-722.
[12]Jansson KA,Bauer HC.Survival,complications and outcome in282 patients operated for neurological deficit due to thoracic or lumbar spinal metastases.Eur Spine J.2006;15(2):196-202.
[13]Polastri M,Gasbarrini A.Vertebroplasty in patients with tumour-related vertebral fractures:is rehabilitation needed?Asian Spine J.2013;7(3):248-252.
[14]Ma XL,Xing D,Ma JX,et al.Balloon kyphoplasty versus percutaneous vertebroplasty in treating osteoporotic vertebral compression fracture:grading the evidence through a systematic review and meta-analysis.Eur Spine J.2012;21(9):1844-1859.
[15]杨学刚,吴戈,李政文,等.骨填充网袋辅助经皮椎体成形术治疗伴椎体后壁破损的脊柱转移瘤[J].介入放射学杂志,2017,26(9):803-806.
[16]De la Garza-Ramos R,Benvenutti-Regato M,Caro-Osorio E.Vertebroplasty and kyphoplasty for cervical spine metastases:a systematic review and meta-analysis.Int JSpine Surg.2016;10:7.
[17]Sadeghi-Naini M,Aarabi S,Shokraneh F,et al.Vertebroplasty and Kyphoplasty for Metastatic Spinal Lesions:A Systematic Review.Clin Spine Surg.2018;31(5):203-210.
[18]王伟军.高黏度与低黏度骨水泥椎体成形术治疗骨质疏松性椎体压缩骨折有效性的Meta分析[J].中华创伤杂志,2018,34(9):806-812.
[19]陈秋洪,胡炳树,李杰,等.经皮椎体成形术治疗脊柱转移瘤的疗效评估[J].中国骨与关节杂志,2018,12(9):681-686.
[20]Farrokhi M,Nouraei H,Kiani A.The Efficacy of Percutaneous Vertebroplasty in Pain Relief in Patients with Pathological Vertebral Fractures due to Metastatic Spinal Tumors.Iran Red Crescent Med J.2012;14(9):523-530.
[21]Liang L,Chen X,Jiang W,et al.Balloon kyphoplasty or percutaneous vertebroplasty for osteoporotic vertebral compression fracture?An updated systematic review and meta-analysis.Ann Saudi Med.2016;36(3):165-174.
[22]He Z,Zhai Q,Hu M,et al.Bone cements for percutaneous vertebroplasty and balloon kyphoplasty:Current status and future developments.J Orthop Translat.2015;3(1):1-11.
[23]Liu W,Zhou S,Wang S.Application of percutaneous vertebroplasty in the treatment of multiple thoracic metastases.Oncol Lett.2015;9(6):2775-2780.
[24]Guo D,Cai J,Zhang S,et al.Treating osteoporotic vertebral compression fractures with intraosseous vacuum phenomena using high-viscosity bone cement via bilateral percutaneous vertebroplasty.Medicine(Baltimore).2017;96(14):e6549.
[25]Ate?A,Gemalmaz HC,Deveci MA,et al.Comparison of effectiveness of kyphoplasty and vertebroplasty in patients with osteoporotic vertebra fractures.Acta Orthop Traumatol Turc.2016;50(6):619-622.
[26]张伟,杨金华,黄开,等.PKP与高粘度骨水泥PVP治疗骨质疏松性椎体压缩骨折的疗效比较[J].中国骨与关节损伤杂志,2017,32(11):1138-1140.
[27]曾森炎,季卫锋,董玉鹏,等.高粘度与低粘度骨水泥PVP治疗骨质疏松性椎体压缩骨的Meta分析[J].中国骨与关节损伤杂志,2018,33(3):240-243.
[28]徐敏,张鸿升,王继,等.高黏度与低黏度骨水泥经皮椎体成形治疗骨质疏松椎体压缩性骨折的Meta分析[J].中国组织工程研究,2017,21(34):5571-5576.
[29]唐冲,吴四军,刘正,等.高粘度骨水泥经皮椎体成形术治疗骨质疏松性椎体压缩骨折的疗效分析[J].中国脊柱脊髓杂志,2017,27(8):720-726.
[30]Yuan WH,Hsu HC,Lai KL.Vertebroplasty and balloon kyphoplasty versus conservative treatment for osteoporotic vertebral compression fractures:A meta-analysis.Medicine(Baltimore).2016;95(31):e4491.
[31]Zeng TH,Wang YM,Yang XJ,et al.The clinical comparative study on high and low viscosity bone cement application in vertebroplasty.Int J Clin Exp Med.2015;8(10):18855-18860.
[2]Yang Z,Tan J,Zhao R,et al.Clinical Investigations on the Spinal Osteoblastic Metastasis Treated by Combination of Percutaneous Vertebroplasty and 125I Seeds Implantation Versus Radiotherapy.Cancer Biother Radiopharm.2013;28(1):58-64.
[3]Mansoorinasab M,Abdolhoseinpour H.A review and update of vertebral fractures due to metastatic tumors of various sites to the spine:Percutaneous vertebroplasty.Interv Med Appl Sci.2018;10(1):1-6.
[4]Liu Y,Wang Y,Zhao L,et al.Effectiveness and safety of percutaneous vertebroplasty in the treatment of spinal metastatic tumor.Pak J Med Sci.2017;33(3):675-679.
[5]Gu YF,Tian QH,Li YD,et al.Percutaneous vertebroplasty and interventional tumor removal for malignant vertebral compression fractures and/or spinal metastatic tumor with epidural involvement:a prospective pilot study.J Pain Res.2017;10:211-218.
[6]Su Y,Sun ZZ,Shen LX,et al.Comparison of percutaneous vertebroplasty with and without interventional tumor removal for spinal metastatic tumor without epidural involvement.JBone Oncol.2017;6:1-7.
[7]Qi L,Li C,Wang N,et al.Efficacy of percutaneous vertebroplasty treatment of spinal tumors:A meta-analysis.Medicine(Baltimore).2018;97(3):e9575.
[8]闫光华,葛顺杰,仇继任,等.经皮椎体成形骨水泥渗漏的治疗与预防[J].中国组织工程研究,2018,22(26):4241-4246.
[9]Martins PC,Couto TE,Gama AC.Auditory perceptual evaluation of the degree vocal deviation:correlation between the Visual Analogue Scale and Numerical Scale.Codas.2015;27(3):279-284.
[10]Monticone M,Baiardi P,Vanti C,et al.Responsiveness of the Oswestry Disability Index and the Roland Morris Disability Questionnaire in Italian subjects with sub-acute and chronic low back pain.Eur Spine J.2012;21(1):122-129.
[11]Masala S,Anselmetti GC,Muto M,et al.Percutaneous Vertebroplasty Relieves Pain in Metastatic Cervical Fractures.Clin Orthop Relat Res.2011;469(3):715-722.
[12]Jansson KA,Bauer HC.Survival,complications and outcome in282 patients operated for neurological deficit due to thoracic or lumbar spinal metastases.Eur Spine J.2006;15(2):196-202.
[13]Polastri M,Gasbarrini A.Vertebroplasty in patients with tumour-related vertebral fractures:is rehabilitation needed?Asian Spine J.2013;7(3):248-252.
[14]Ma XL,Xing D,Ma JX,et al.Balloon kyphoplasty versus percutaneous vertebroplasty in treating osteoporotic vertebral compression fracture:grading the evidence through a systematic review and meta-analysis.Eur Spine J.2012;21(9):1844-1859.
[15]杨学刚,吴戈,李政文,等.骨填充网袋辅助经皮椎体成形术治疗伴椎体后壁破损的脊柱转移瘤[J].介入放射学杂志,2017,26(9):803-806.
[16]De la Garza-Ramos R,Benvenutti-Regato M,Caro-Osorio E.Vertebroplasty and kyphoplasty for cervical spine metastases:a systematic review and meta-analysis.Int JSpine Surg.2016;10:7.
[17]Sadeghi-Naini M,Aarabi S,Shokraneh F,et al.Vertebroplasty and Kyphoplasty for Metastatic Spinal Lesions:A Systematic Review.Clin Spine Surg.2018;31(5):203-210.
[18]王伟军.高黏度与低黏度骨水泥椎体成形术治疗骨质疏松性椎体压缩骨折有效性的Meta分析[J].中华创伤杂志,2018,34(9):806-812.
[19]陈秋洪,胡炳树,李杰,等.经皮椎体成形术治疗脊柱转移瘤的疗效评估[J].中国骨与关节杂志,2018,12(9):681-686.
[20]Farrokhi M,Nouraei H,Kiani A.The Efficacy of Percutaneous Vertebroplasty in Pain Relief in Patients with Pathological Vertebral Fractures due to Metastatic Spinal Tumors.Iran Red Crescent Med J.2012;14(9):523-530.
[21]Liang L,Chen X,Jiang W,et al.Balloon kyphoplasty or percutaneous vertebroplasty for osteoporotic vertebral compression fracture?An updated systematic review and meta-analysis.Ann Saudi Med.2016;36(3):165-174.
[22]He Z,Zhai Q,Hu M,et al.Bone cements for percutaneous vertebroplasty and balloon kyphoplasty:Current status and future developments.J Orthop Translat.2015;3(1):1-11.
[23]Liu W,Zhou S,Wang S.Application of percutaneous vertebroplasty in the treatment of multiple thoracic metastases.Oncol Lett.2015;9(6):2775-2780.
[24]Guo D,Cai J,Zhang S,et al.Treating osteoporotic vertebral compression fractures with intraosseous vacuum phenomena using high-viscosity bone cement via bilateral percutaneous vertebroplasty.Medicine(Baltimore).2017;96(14):e6549.
[25]Ate?A,Gemalmaz HC,Deveci MA,et al.Comparison of effectiveness of kyphoplasty and vertebroplasty in patients with osteoporotic vertebra fractures.Acta Orthop Traumatol Turc.2016;50(6):619-622.
[26]张伟,杨金华,黄开,等.PKP与高粘度骨水泥PVP治疗骨质疏松性椎体压缩骨折的疗效比较[J].中国骨与关节损伤杂志,2017,32(11):1138-1140.
[27]曾森炎,季卫锋,董玉鹏,等.高粘度与低粘度骨水泥PVP治疗骨质疏松性椎体压缩骨的Meta分析[J].中国骨与关节损伤杂志,2018,33(3):240-243.
[28]徐敏,张鸿升,王继,等.高黏度与低黏度骨水泥经皮椎体成形治疗骨质疏松椎体压缩性骨折的Meta分析[J].中国组织工程研究,2017,21(34):5571-5576.
[29]唐冲,吴四军,刘正,等.高粘度骨水泥经皮椎体成形术治疗骨质疏松性椎体压缩骨折的疗效分析[J].中国脊柱脊髓杂志,2017,27(8):720-726.
[30]Yuan WH,Hsu HC,Lai KL.Vertebroplasty and balloon kyphoplasty versus conservative treatment for osteoporotic vertebral compression fractures:A meta-analysis.Medicine(Baltimore).2016;95(31):e4491.
[31]Zeng TH,Wang YM,Yang XJ,et al.The clinical comparative study on high and low viscosity bone cement application in vertebroplasty.Int J Clin Exp Med.2015;8(10):18855-18860.
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