Shi Guan, Feng Fei, Chen Hao, Jia Pu, Bao Li, Tang Hai
Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
J Pain Res. 2019 Mar 25;12:1053-1060. doi: 10.2147/JPR.S193564. eCollection 2019.
The spine is the most common skeletal site for metastatic tumors. In the treatment of vertebral metastases, the absolutely safe number of levels that can be treated via percutaneous kyphoplasty (PKP) during one procedure remains controversial. Thus, the present study aimed to evaluate the safety and efficacy of multilevel (>3) PKP for painful osteolytic vertebral metastases. We retrospectively analyzed the data from 176 patients who received PKP for painful osteolytic spinal metastases. Group A (n=104) received PKP at a maximum of three vertebral levels per procedure, while group B (n=72) received PKP at more than three levels during one operation. Surgical efficacy was assessed via a comparison of the VAS, Oswestry Disability Index (ODI), and general health (GH) and mental health (MH) scores of the Short Form-36 Health Survey before and after PKP. The complications were observed to evaluate the safety. Both groups had significantly improved VAS, ODI, GH and MH scores after PKP (<0.05). One week after surgery, group A had significantly less pain (VAS 3.41±0.1) than group B (VAS 3.74±0.13) (<0.05). At 3 and 6 months postoperatively, the GH score was more significantly improved in group A than group B (<0.05). There were no significant differences between the two groups in the ODI, MH score, and complications (>0.05). Multilevel PKP is safe and results in effective pain relief, and improvement of spinal mobility and GH in patients with osteolytic vertebral metastases. However, patients who undergo PKP at more than three levels have slightly worse short-term pain relief (less than 1 week postoperatively) and improvement of GH in the long-term (more than 3 months postoperatively) compared with patients who undergo PKP at less than three levels.
脊柱是转移性肿瘤最常见的骨骼部位。在椎体转移瘤的治疗中，经皮椎体后凸成形术（PKP）单次手术可治疗的绝对安全节段数量仍存在争议。因此，本研究旨在评估多节段（>3个）PKP治疗疼痛性溶骨性椎体转移瘤的安全性和有效性。我们回顾性分析了176例因疼痛性溶骨性脊柱转移瘤接受PKP治疗患者的数据。A组（n=104）每次手术最多在3个椎体节段进行PKP，而B组（n=72）在一次手术中接受超过3个节段的PKP。通过比较PKP前后的视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）以及简短健康调查问卷36项简表（SF-36）中的总体健康（GH）和心理健康（MH）评分来评估手术疗效。观察并发症以评估安全性。两组患者PKP后VAS、ODI、GH和MH评分均有显著改善（<0.05）。术后1周，A组疼痛程度（VAS 3.41±0.1）显著低于B组（VAS 3.74±0.13）（<0.05）。术后3个月和6个月，A组的GH评分改善程度比B组更显著（<0.05）。两组在ODI、MH评分和并发症方面无显著差异（>0.05）。多节段PKP是安全的，可有效缓解疼痛，改善溶骨性椎体转移瘤患者的脊柱活动度和总体健康状况。然而，与接受少于3个节段PKP的患者相比，接受超过3个节段PKP的患者短期（术后不到1周）疼痛缓解稍差，长期（术后超过3个月）GH改善程度稍低。
