Kirkegaard Andreas Ole, Sørensen Simon Thorbjørn, Ziegler Dorthe Schøler, Carreon Leah, Andersen Mikkel Østerheden, Rousing Rikke
Dan Med J. 2018 Oct;65(10).
In cancer patients with painful vertebral fractures due to spinal metastasis, traditional pain-relieving therapies include analgesics, bed rest, steroids, radio-ther-apy, etc. These treatment modalities are often ineffective. Traditional spinal surgery in general anaesthesia is usually not an option in patients with advanced cancer and in a poor general condition. Percutaneous vertebroplasty (PVP) has been reported as a minimally invasive treatment option with apparent rapid pain relief compared with other conventional treatment options. The objective of this study was to assess the safety and efficacy of PVP in patients with malignant spinal lesions.
From the National Danish Surgical Spine Database, DaneSpine, 30 consecutive cancer patients with vertebral fractures who underwent PVP from 2013 to 2017 were identified. From DaneSpine, the European Quality of Life - 5 Dimensions Questionnaire (EQ-5D) and the Oswestry Disability Index (ODI) scores were collected pre- and post-operatively. Data on the incidence of complications and poly-methyl methacrylate leaks were obtained by review of medical records and plain post-operative X-rays.
The mean improvement in EQ-5D scores from baseline was 0.30 (p < 0.01) after three months, and 0.25 (p = 0.01) after one year. The ODI improved from 44.1 to 23.3 (p < 0.01). Despite a cement leakage rate of 14.8%, no patients presented with any clinically significant symptoms.
PVP is a safe procedure providing a statistically significant and clinically relevant improvement in quality of life and function of patients with cancer-related vertebral compression fractures. Our findings may provide useful information to healthcare professionals who are treating cancer.
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在因脊柱转移而发生疼痛性椎体骨折的癌症患者中，传统的止痛疗法包括使用镇痛药、卧床休息、使用类固醇、放射治疗等。这些治疗方式往往效果不佳。对于晚期癌症且全身状况较差的患者，一般不选择在全身麻醉下进行传统脊柱手术。经皮椎体成形术（PVP）已被报道为一种微创治疗选择，与其他传统治疗选择相比，其能明显快速缓解疼痛。本研究的目的是评估PVP在恶性脊柱病变患者中的安全性和有效性。
从丹麦国家外科脊柱数据库DaneSpine中，确定了2013年至2017年连续接受PVP治疗的30例椎体骨折癌症患者。从DaneSpine中收集患者术前和术后的欧洲生活质量五维度问卷（EQ-5D）和奥斯威斯功能障碍指数（ODI）评分。通过查阅病历和术后普通X线片获取并发症发生率和聚甲基丙烯酸甲酯渗漏的数据。
三个月后EQ-5D评分较基线的平均改善为0.30（p<0.01），一年后为0.25（p = 0.01）。ODI从44.1改善至23.3（p<0.01）。尽管骨水泥渗漏率为14.8%，但没有患者出现任何具有临床意义的症状。
PVP是一种安全的手术，能在统计学上显著且在临床上切实改善癌症相关椎体压缩骨折患者的生活质量和功能。我们的研究结果可能为治疗癌症的医护人员提供有用信息。
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