| Objectives: To evaluate the factors affecting the effect of percutaneous vertebroplasty(PVP)on alleviating the pain for patients with malignant vertebral tumors and to analyze related techniques.Material and Method: Clinical data of 201 patients with refractory and painful malignant spinal tumor undergone PVP were analyzed retrospectively.The analgesic effect of the treatment was evaluated by comparing VAS score before and after PVP,and it was recognized as effective if the score was 3 points lower after treatment.Factors might affect analgesic effect include age,sex,vertebral lesion location(thoracic vertebrae,thoracolumbar segment,or lumbar vertebrae),primary tumor origin(lung cancer or non-lung cancer),lesion nature of the tumor(osteoblastic,mixed or osteolytic type),amount of bone cement used,bone cement leakage,as well as the bone cement filling degree within tumor(classified into three grades,i.e.excellent,filling rate of bone cement equal to or greater than 2/3;good,the rate was between 1/3 and 2/3;poor,the rate was smaller than 1/3).Univariate and multivariate analysis were performed on these factors.For univariate analysis,independent-sample t test was performed on continuous variables,while Chi-square test was performed on categorical variables.Logistic regression was performed for multivariable analysis.Independent-sample t test was performed to analyze whether there are some difference on the amount of bone cement used between the cement leaking vertebrae and the non-cement leaking vertebrae.The difference of VAS score between the different time points(before PVP,one day,one week,one month,and three month after PVP),fluoroscopy duration and the amount of bone cement use during PVP in the different groups(osteoblastic,mixed,or the osteolytic type)were analyzed by using one way ANOVA.Results:For the 201 patients(135 male and 66 female)with malignant vertebral tumor,201 lesion vertebrae were treated with PVP.The average age of the patients was 58.1±11.2 years old(the range was 30~841).The patients were followed for 3 months after treatment,and found that 81.1%(163/201)of them were effectively treated,with 34 having complete alleviation of pain,and 129 partial alleviation of pain.Univariate and multivariate analysis showed that the bone cement filling degree within tumor was the relevant factor in affecting the analgesic effect of PVP,for the univariate analysis,the Chi-square value was 2.702,P <0.05;and for the multivariate analysis of Logistic regression,its result showed that the OR value is 28.913(95%CI:10.030~83.344,P =0.000).The amount of bone cement used in the leakage vertebral group was 3.6±1.1ml,whereas in the non-leakage vertebrae was 3.0±0.7 ml(t =5.047?P<0.05,).The VAS score before PVP,one day,one week,one month and three month after PVP was 7.9±1.1?3.4±1.6?3.0±1.8?3.2±1.9?3.4±1.8 respectively.There is significant difference among the scores of VAS at different time points(F =303.637,P<0.05).The fluoroscopy duration for the different lesion nature of the vertebral tumor(osteoblastic type,mixed type or the osteolytic type)were 16.9±2.6min,10.7±2.3 min,and 10.5±2.1 min,respectively,F =96.705,P<0.05;The amount of bone cement used were 2.6±1.0 ml,3.0±0.9 ml,3.4±0.8 ml,respectively,F =9.020,P<0.05.Conclusion: The bone cement filling degree within tumor is the key factor in affecting the analgesic effect of PVP treating malignant vertebral tumor,and the better the bone cement filling degree,the better the analgesic effect.The analgesic effect of PVP in the treatment of malignant vertebral tumor of different types was the same satisfactory.However,in the treatment of osteoblastic metastatic spinal tumor,the operational techniques involved was relatively complicated,therefore,the puncture skills and the amount of bone cement used should be well considered.The amount of bone cement used during procedure is not a risk factor in affecting the analgesic effect of PVP treating malignant vertebral tumor. |
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