| ?Objective?To study the application of percutaneous vertebroplasty(PVP)in spinal metastases and evaluate its clinical efficacy.?Methods?A retrospective study was conducted.From January 2014 to December 2015,37 patients,including 25 males and 12 females,which aged from 36 to 84 years old,mean 61.8 years old,with spinal metastases treated with PVP in our hospital were enrolled in the study.There were 78 vertebral bodies treated in total,including 40 thoracic vertebral bodies and 38 lumbar vertebral bodies(53 males and 25 females).Also they can be devide into groups according to the original primary tumor source: 19 cases from lung cancer,3 cases from breast cancer,5 cases from prostate cancer,2 cases from cervical cancer,1 case from ovarian cancer,2 cases from liver cancer,2 cases from gastric cancer,2 cases from colon cancer and 1 case from rectal cancer.All the patients were rated through the Tokuhashi Score.11 of them were rated under or equal to 5 points while 26 of them were rated between 6 to 8 points.Diagnosis depends mainly on the medical history and imaging examination.All cases were confirmed by biopsy.The preoperative and postoperative pain scores(preoperative,postoperative 24 h,1 week and 3 months),quality of life scores(preoperative and postoperative comparison)were performed using Visual Analogue Scale(VAS).In preoperative and postoperative 3 months,the height of vertebral anterior,vertebral margin,vertebral posterior were measured and compared.Then according to analytical statistics,the resulting data was processed.?Results?After the treatment of PVP,the pain situation in 32 cases were relieved while in 5 cases it was invalid.Before PVP treatment the VAS score was 7.35±1.23 points,1.83±1.31 points 24 hours after treatment,2.04±1.31 points 1 week after treatment and 2.23±1.34 points 3 months after treatment,suggesting that PVP treatment can achieve significant pain relief(P <0.05).ADL score was 16.16±2.70 points preoperatively.At 3 months follow-up,ADL score was 10.05±2.82 points,showing that the daily self-care ability of PVP treatment significantly improved than that of preoperative(P <0.05),and the difference was statistically significant(P <0.05).The posterior,middle and trailing height of PVP before treatment were 19.10±0.48 mm,18.40±0.63 mm and 19.81±0.78 mm respectively.After treatment,19.10±0.47 mm,18.40±0.59 mm,19.81±0.74 mm respectively.There was no significant change in height between each two groups(P> 0.05).Among all the 78 vertebral bodies treated with PVP,19 cases were found having vertebral leakage through imaging examination,including 8 cases of intervertebral disc leakage(3 thoracic,5 lumbar),10 cases of paraspinal soft tissue Leakage(5 thoracic vertebrae,4 lumbar vertebrae)and paravertebral vein leakage 1(1 lumbar).The incidence of leakage was 24.5%.The leaks were found through intraoperative fluoroscopy.And further bone cement injection was immediately stop.Postoperative spine X-ray could further confirm the leakage of bone cement.Spinal leakage were not found in all patients.At 3 months postoperative,1 adjacent vertebral body fracture case occurred.The case was retreated with bone cement injection,and symptoms were relieved obviously.Bleeding,postoperative infection,spinal cord or nerve root compression symptoms,pulmonary embolism and other serious complications were not found in any of these cases.No deaths.?Conclusion?Percutaneous vertebroplasty(PVP)can significantly relieve pain,improve the quality of life of the patients with spinal metastases and to a certain extent,maintain the spinal stability.PVP,as a treatment for spinal metastases,is feasible and safe. |
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