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目的探讨开放性减压椎体成形联合微波高温疗法治疗脊柱转移瘤的临床疗效。方法回顾性分析2008年10月至2011年1月间收治的29例行开放性椎管减压内固定联合病椎微波高温疗法椎体成形术的脊柱转移瘤患者资料,其中24例患者获得>1年的随访。观察患者术后内固定位置及骨水泥分布和渗漏情况,以疼痛视觉模拟评分(VAS)和Frankel分级评定患者疼痛缓解和神经功能的改善情况。结果 29例患者手术均顺利完成,未发生脊髓和神经根损伤情况。术后VAS评分较术前有明显改善(P<0.05);末次随访时Frankel分级:A级1例,B级4例,C级8例,D级7例,E级4例,与术前比较差异有统计学意义(P<0.05)。5例患者手术中出现骨水泥椎旁渗漏,但均无不适症状。随访过程中肿瘤无复发,椎体无骨折塌陷,内固定物无松动、断裂和移位。结论开放性椎管减压内固定联合病椎微波高温疗法椎体成形术可迅速减轻患者的疼痛症状,在有效维持脊柱序列的同时可充分解除脊髓压迫,是治疗脊柱转移瘤的有效术式。
Objective To investigate the clinical effect of open decompression and vertebroplasty combined with microwave hyperthermia in the treatment of spinal metastases. Methods A retrospective analysis of 29 patients with spinal metastases treated with open vertebral decompression and internal fixation combined with vertebral hyperthermia during vertebroplasty from October 2008 to January 2011 was retrospectively analyzed. Twenty-four of the patients received> 1 year follow-up. The position of postoperative internal fixation and the distribution and leakage of bone cement were observed. VAS and Frankel grading were used to evaluate the pain relief and the improvement of neurological function. Results All the 29 cases were successfully performed without spinal cord and nerve root injury. The postoperative VAS score was significantly improved compared with that before operation (P <0.05). At the last follow-up, the Frankel classification included Grade A in 1 case, Grade B in 4 cases, Grade C in 8 cases, Grade D in 7 cases and Grade E in 4 cases. The difference was statistically significant (P <0.05). Five patients had paravertebral leakage during operation, but no symptoms. No tumor recurrence during follow-up, vertebral fractures without collapse, internal fixation without loosening, rupture and displacement. Conclusion Open vertebral canal decompression and internal fixation combined with vertebroplasty and hyperthermia can effectively relieve pain symptoms of patients. It can effectively relieve spinal cord compression while maintaining spinal sequence effectively. It is an effective method to treat spinal metastases.