射频消融辅助椎体次全切除术治疗脊柱转移瘤的效果及安全性评价

目的 评价射频消融（radiofrequency ablation,RFA）辅助椎体次全切除术治疗脊柱转移瘤的效果及安全性.方法 选择行RFA辅助椎体次全切除术治疗的32例脊柱转移瘤（研究组）和单纯行椎体次全切除术治疗的51例脊柱转移瘤患者（对照组）.记录2组患者的手术时间、术中出血量;于术前,术后1周、1个月、3个月、6个月行疼痛视觉模拟评分（visual analogue scale,VAS）,评价疼痛缓解情况;并采用Frankel脊髓损伤分级和美国东部肿瘤协作组（Eastern Cooperative Oncology Group,ECOG）分级评价脊髓功能;记录复发及并发症.结果 研究组手术时间较对照组短、术中出血量较对照组少（P＜0.05）.2组术后1周、1个月、3个月、术后6个月VAS均较术前显著降低（P＜0.01）,2组间差异无统计学意义（P＞0.05）.2组疼痛缓解有效率差异无统计学意义（87.50％ vs82.35％,P＞0.05）.2组术后Frankel分级和ECOG分级平均改善1级.随访期间研究组复发率显著低于对照组（28.13％ vs 68.63％,P＜0.05）,但2组病死率差异无统计学意义（15.63％ vs 13.73％,P＞0.05）.结论 RFA辅助椎体次全切除术可缩短手术时间、减少出血、减轻术后疼痛、降低术后复发率,获得较好的治疗效果,较单纯椎体次全切除术有一定优势,值得临床借鉴.

INVESTIGATION OF EFFICACY AND SAFETY OF RADIOFREQUENCY ABLATION COMBINED WITH SUBTOTAL CORPECTOMY IN TREATING METASTATIC TUMOR OF SPINE

Objective To investigate the efficacy and safety of radiofrequency ablation （RFA） combined with subtotal corpectomy in treating metastatic tumor of the spine.Methods Thirty-two patients with metastatic tumor of the spine underwent RFA combined with subtotal corpectomy （study group） and 51 patients underwent single subtotal corpectomy （control group） were selected in this study.The operation time and mean intraoperative bleeding were recorded,visual analogue scale （VAS） score was performed before surgery and 1 week,1 month,3 months,6 months after surgery for all patients,and pain relief was evaluated.Frankel scale and Eastern Cooperative Oncology Group （ECOG） scale were performed to evaluate the spine function.The recurrence and complication of all patients were also recorded.Results Study group had shorter operation time and less mean intraoperative bleeding than control group （P ＜ 0.05）.The VAS scores 1 week,1 month,3 months,6 months after surgery were significantly decreased than those before surgery （P ＜ 0.01）,but no statistical difference was observed between the two groups （P ＞ 0.05）.There was no statistical difference in pain relief efficiency between the two groups（87.50％ vs 82.35％,P ＞0.05）.Both Frankel scale and ECOG scale were improved 1 grade after surgery.Follow-up showed that study group had lower recurrence rate （28.13％ vs 68.63％,P ＜0.05） and similar mortality rate （15.63％ vs 13.73％,P ＞ 0.05） compared with control group.Conclusion RFA combined with subtotal corpectomy can shorten the operation time,lessen the mean intraoperative bleeding,relieve the postoperative pain,decrease recurrence rate and gain good therapeutic effect,it has certain advantages than simple subtotal corpectomy,thus it is worthy of application in clinic.