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目的微波治疗四肢和骨盆骨肿瘤已取得满意的临床疗效,由于脊柱解剖结构的特殊性,微波应用面临挑战。本研究探讨经皮椎弓根内固定开放性减压联合微波高温灭活治疗脊柱转移瘤的临床疗效。方法回顾性分析广西医科大学附属肿瘤医院2013-10-15-2015-02-15收治的23例脊柱转移瘤患者的临床资料。所有患者均采用经皮椎弓根内固定开放减压联合微波高温消灭火治疗脊柱转移瘤。其中男9例,女14例;年龄42~72岁,平均年龄56岁,中位年龄62岁。Tomita预后评分3~6分。采用疼痛视觉模拟评分(VAS)比较术前、术后疼痛情况,Frankel分级评定患者神经功能的改善情况及观察患椎椎体后缘的高度变化。结果 23例患者手术均顺利完成,未发生脊髓和神经根损伤或加重情况。术后3d VAS评分(3.8±1.4)和末次随访VAS评分(4.1±1.5)较术前(7.9±2.6)有明显改善(t=-6.659,P<0.001;t=-6.071,P<0.001),术后3d椎体后缘高度(15.6±3.2)mm与术前(10.5±2.5)mm比较差异有统计学意义(t=6.023,P<0.001),与末次随访(14.6±2.8)比较,差异无统计学意义(t=1.128,P=0.133);末次随访时Frankel分级,A级1例,B级2例,C级6例,D级9例,E级5例,与术前比较差异有统计学意义,χ2=10.856,P=0.028。随访过程中无肿瘤复发,无椎体骨折塌陷,无内固定物松动、断裂和移位。结论经皮椎弓根内固定开放性椎管减压内固定联合微波高温灭活术可迅速减轻患者的疼痛症状,在有效维持脊柱稳定性的同时可充分解除脊髓压迫,控制局部复发,取得满意的治疗效果,但远期效果有待进一步观察。
Objective Microwave treatment of limbs and pelvic bone tumors have achieved satisfactory clinical efficacy, due to the particularity of the anatomy of the spine, microwave applications are facing challenges. This study was to investigate the clinical effect of percutaneous pedicle screw fixation combined with open decompression and microwave hyperthermia inactivation of spinal metastases. Methods The clinical data of 23 patients with spinal metastases who were admitted to Cancer Hospital of Guangxi Medical University during 2013-10-15-2015-02-15 were retrospectively analyzed. All patients were treated with percutaneous pedicle screw fixation open decompression combined with microwave hyperthermia ablation of fire treatment of spinal metastases. Including 9 males and 14 females; aged 42 to 72 years, mean age 56 years old, the median age of 62 years. Tomita prognosis score 3 to 6 points. The pain visual analogue scale (VAS) was used to compare the preoperative and postoperative pain, the improvement of neurological function by Frankel grading and the height change of the posterior edge of the vertebral body. Results All the 23 cases were successfully completed without injury or aggravation of spinal cord and nerve root. The postoperative VAS score (3.8 ± 1.4) and the last follow-up VAS score (4.1 ± 1.5) were significantly improved compared with preoperative (7.9 ± 2.6) (t = -6.659, P <0.001; t = -6.071, P <0.001) The height of the posterior border of the vertebral body at 3 days postoperatively was significantly lower than that of the last follow-up (14.6 ± 2.8) at 15.6 ± 3.2 mm and 10.5 ± 2.5 mm, respectively (t = 6.023, P <0.001) The difference was not statistically significant (t = 1.128, P = 0.133). Frankel classification at the last follow-up showed that there were 1 case of grade A, 2 cases of class B, 6 cases of class C, 9 cases of class D and 5 cases of class E, The difference was statistically significant, χ2 = 10.856, P = 0.028. No tumor recurrence during follow-up, no collapse of vertebral fractures, no loosening, rupture and displacement of internal fixation. Conclusion Percutaneous pedicle screw fixation and open endovascular decompression and internal fixation combined with microwave hyperthermia can rapidly relieve the pain symptoms of patients and effectively relieve the spinal stability while relieving spinal cord compression and controlling local recurrence with satisfaction The treatment effect, but the long-term effect needs further observation.