经皮椎体成形术和椎体后凸成形术治疗脊柱恶性肿瘤的临床应用

目的探讨并比较经皮椎体成形术(PVP)与椎体后凸成形术(PKP)治疗脊柱恶性肿瘤的临床应用价值。方法自2007年12月-2011年7月苏州大学附一医院对45例脊柱恶性肿瘤患者实施PVP或PKP,其中PVP组30例46节椎体、PKP组15例20节椎体。通过观察两组住院时间、住院费用、并发症、疼痛视觉模拟评分(VAS)和日常生活活动能力评分(改良巴氏指数BI)来评价治疗效果。结果术后两组VAS评分及BI评分与术前比较差异有统计学意义(P<0.05),两组间VAS评分和BI评分差值比较无统计学意义(P>0.05)。两组间住院时间及住院费用比较差异有统计学意义(P<0.05),PVP治疗费用及住院时间低于PKP组(P<0.05)。PVP组、PKP组骨水泥渗漏的发生率为分别为30%(9例)、13.3%(4例),差异有统计学意义(P<0.05)。两组均无肺栓塞等严重并发症发生。结论采用PVP及PKP治疗脊柱恶性肿瘤均能迅速改善临床症状。PKP骨水泥渗漏发生率低,但价格昂贵,住院时间长;PVP组操作简便,疗效确切,费用低廉,但骨水泥渗漏发生率相对较高。

Clinical application of percutaneous vertebroplasty and kyphoplasty in treating malignant tumors of spine

Objective To evaluate percutaneous vertebroplasty(PVP) and percutaneous kyphoplasty (PKP) in treating malignant tumors of thoracolumbar spine,and to compared the advantages and disadvantages of PVP and PKP.Methods During the period from Dec.2007 to July 2011,PVP or PKP was carried out in 45 patients with thoracolumbar tumors in authors’ hospital.PVP group included 30 cases with 46 diseased vertebrae,and PKP group had 15 cases with 20 diseased vertebrae.The hospitalization days, hospitalization cost and the incidence of complications were recorded,and the visual analogue pain scale (VAS) and the activities of daily living scale(BI) were measured before operation as well as at one week, one and 3 months after operation.The results were analyzed and the therapeutic effects were evaluated. Results Statistically significant difference in VAS scores and BI scores existed between preoperative data and postoperative ones in both groups(P < 0.05),although no significant differences in VAS scores and BI scores existed between PVP group and PKP group(P > 0.05).Also statistically significant differences in hospitalization days and hospitalization cost were present between the two groups.The hospitalization time and hospitalization cost of PVP group were significantly shorter and less than those of PKP group(P < 0.05).The incidence of bone cement leakage in PVP group and PKP group was 30%(n = 9) and 13.3%(n = 4) respectively,and the difference between the two groups was statistically significant(P < 0.05).No severe complications such as pulmonary embolism occurred in both groups.Conclusion In treating malignant tumors of thoracolumbar spine,PVP and PKP can quickly relieve the pain and enhance the vertebral stability. PKP has lower incidence of bone cement leakage,but it costs more and needs longer hospitalization time. PVP is easy to be performed and has reliable effectiveness with lower cost, although it carries relatively higher incidence of bone cement leakage.