| BackgroundPercutaneous Vertebroplasty is a minimally invasive surgical technique designed to increase the strength and stability of the vertebral body by percutaneous injection of bone cement into the vertebral body,to kill tumor cells locally at high temperatures,to relieve pain,and even to partially restore the height of the vertebral body[1].It has been widely used in the treatment of spinal compression fractures,vertebral osteolysis and other diseases.Bone cement is Polymethyl Methacrylate(PMMA).The earliest use of bone cement can be traced back to 1979 when Charnley applied bone cement in fixed orthopedic transplantation.After that,the development of bone cement gradually matured,and now it has been used in joint replacement?bone defect?and fracture adhesive fixation treatment[2].Because PMMA materials can release high temperature locally during the process of gradual solidification by adhesives,resulting in local killing effect,which is the theoretical basis for our application to the osteoblastic vertebral body.Spinal metastatic tumor is a common type of clinical tumor.It is a common site of metastatic of cancers.The common primary tumors are lung,breast,kidney,prostate and thyroid ancer[3].Due to the different nature of the primary tumor,different pathological changes can be formed after metastasis to the vertebral body of the spine,which can be divided into osteoblastic metastasis(1.6%)?osteolytic metastasis(7.8%)and mixed bone metastasis(20.1%)[4].Traditional treatments for spinal metastases include surgery?medication?chemotherapy and a combination of treatments[5].The treatments of spinal metastases concept in the past few years has witnessed great progress,mainly embodied in the following aspects[6]:firstly,for the application of stereotactic radiotherapy,stereotactic radiotherapy can accurately by direction system against tumors cells,the adjacent normal tissue cells from ray killed,and studies have demonstrated that local tumors after radiation therapy can be lasting control;secondly,it is generally believed that surgery still has curative effect,but different from the previous one,surgical methods and indications have become much more conservative,and traditional open surgery is gradually moving towards minimally invasive treatment;thirdly,the applications of targeted drugs has brought the dawn of victory to patients.After several courses of treatment,the tumors body has become smaller and the symptoms have been alleviated,which can even be used as part of the preoperative preparation.On this basis,the success rate of surgery can be improved and the recurrence rate of postoperative tumors can be reduced.At present,patients with osteoblastic spinal lesions are often encountered clinically,and most of the osteoblastic lesions of the spine are caused by prostate cancer,which is the most common malignant tumor in male cancer patients,second only to lung cancer in the world[7].For osseous metastasis lesions,using percutaneous vertebral plasty to polymethyl methacrylate(PMMA)into the treatments of history,there are a few clinical studies have confirmed the effectiveness of the proposed method[8],but injected methacrylate(PMMA)after vertebral body cavity caused by increased internal pressure brought about by the risk of postoperative leakage of bone cement,still for many clinical obstacle in front of a line workers,and even some scholars think that this operation method is not safe[9].In this context,it is a practical and theoretical significance to study the safety and efficacy of bone cement,which is injected into osteoblastic vertebra.ObjectionTreatment of vertebral body bone cement into the safety of osseous metastasis has been controversial,for this kind of contradictory opinions,this study through the retrospective analysis of undergraduate course room of spinal metastasis of prostate cancer patients,exploring the efficacy and safety of percutaneous vertebroplasty,confirmed disease treatment of vertebral bone cement injection development can serve as a clinical routine treatment.,providing theoretical basis for medical workers.MethodsA retrospective analysis was performed on 36 patients with spinal metastasis of prostate cancer enrolled in the undergraduate program from September 2009 to May 2019,8 patients receiving drug therapy alone were included in the control group and 28 patients receiving percutaneous vertebroplasty combined with drug therapy were included in the experimental group.Aged 65 to84 years,with an average age of(72.5±4.7)years,all the patients were followed up for at least 3 months.The clinical efficacy of percutaneous vertebroplasty was evaluated by Visual Analogue Score(VAS)?Karnofsky Performance Scale(KPS)?Oswestry Disability Index(ODI)?dosage of cancer three-step analgesics?bed time?efficient/inefficient?bone cement injection volume and distribution.Statistical data were calculated by SPSS22.0,values were expressed by mean standard deviation,preoperative and postoperative changes in relevant values were analyzed by single factor repeated measurement analysis of variance,and P<0.05 was considered statistically significant.ResultsControl group:there was no significant difference in pain VAS?KPS?ODI score at baseline and at each follow-up(P>0.05),and the mean analgesic dosage was(189.53±74.62)mg/d?the average bed time was(12.96±0.85)d.Experimental group:the amount of bone cement was 1.5-4ml,with an average of(2.3 1 ±0.73)ml,the bone cement was well filled with no leakage.Mean VAS scores significantly decreased from(8.62±0.53)before the procedure to(3.52±1.31)by day 1 after the procedure and were(2.52±0.91)at 1 month,(2.14±0.63)at 3 month,(P<0.05),ODI and KPS scores also changed after the procedure,with significant differences between baseline scores and at each follow-up examination(P<0.05).The average analgesic dosage decreased significantly from preoperative(186.74±54.30)mg/d to postoperative(61.72±31.54)mg/d,and the average bed time was(2.61±0.53)d.The analgesic dosage and bed time of the experimental group were significantly lower than those of the control group.Efficiency far outweights inefficiency.ConclusionFor patients with vertebral osteoblastic metastasis,bone cement filling can rapidly relieve pain,improving the quality of life of patients and shorten the time in bed,which can be used as an effective and safe minimally invasive treatment. |
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