| Objective:The study was designed to explore the curative effect of percutaneous vertebroplasty（PVP）combined with zoledronic acid in the treatment of malignancy thoracolumbar metastasis.Materials and methods:The clinical date of 77 cases with malignant tumors with thoracolumbar metastatases were collected retrospectively in the Fifth Affiliated Hospital of Guangxi Medical University（Nanning First People’s Hospital）from January 2014 to June 2019.The survival time of all patients were estimated at more than 3 months before surgery by revised Tokuhashi score[1]and Tomita score[2].77 cases were randomly divided into two groups,deploying different method,surgical group（n=40,79 vertebrae）was treated with percutaneous puncture bone cement perfusion vertebroplasty（PVP）,while combined group（n=37,73 vertebras）,on the basis of percutaneous vertebroplasty of the diseased vertebrae treatments,received an intravenous drip of zoledronic acid within 24 hours after operation,and the infusion time was not less than 15 minutes,once a month,consecutively 6 times.Both groups of patients suffered varying degrees of chest pain,back pains and limited mobility before surgery.A few patients had mild nerve root or spinal cord compression symptoms.According to Frankel’s classification,3 cases were grade C（2 cases in the surgery group,1 cases in the combined group）and 5cases were grade D（3case in the surgery group and 2 case in the combined group）.Nearly 24-48 hours after surgery,the bone cement leakage of all patients were evaluated by imaging examination and the specific type of leakage was recorded;both groups were evaluated on their pain degree by filling out Visual analogue scale before surgery and at 48 hours,3 months and 6 months after surgery;and besides,measurements and records were made of the changes in the height of the leading edge of the diseased vertebrae before surgery and at 48 hours,6 months after surgery;during follow-up,it was necessary to pay attention to observing whether there were new vertebral metastases.All the collected relevant indicators were analyzed by corresponding statistics and conclusions were drawn.Results:Patients in both groups were followed up for more than 3 to 6months.During the follow-up period,7 patients died in the combined group（2case died of other organs metastasis,5 case died from the deterioration of the primary tumor）,35 people lived for 3 months after surgery and 30 people survived 6 months after surgery;There were 17 deaths in the surgery group（4cases died of other organs metastasis,13 cases died of primary tumor deterioration）,36 patients survived 3 months after operation and 23 survived 6months after operation.The parameters in the comparative study include:（1）the general indicators of the study data:1)the patients’gender,age,length of stay,follow-up time,segmental distribution of metastases in the thoracolumbar spine,and the amount of cement injected into the diseased vertebrae;2)the Tomita and revised Tokuhashi score of patients in two groups before surgery.（2）Efficacy evaluation indicators:1)the VAS score of before surgery and 48 hours,3 months and 6 months after surgery;2)The height changes of the leading edge of the diseased vertebrae before surgery and at 48 hours,6 months after surgery;3)New vertebral metastasis.The statistical data was obtained:（1）there was no significant difference in gender,age,length of stay,follow-up time,and distribution of metastatic tumors in the thoracolumbar spine between surgical group and combined group（P>0.05）;（2）There was statistically insignificant difference in Tomita and revised Tokuhashi score in two groups before surgery（P>0.05）;（3）No statistically significant difference in the amount of injected vertebral cement was observed between surgical group and combined group（P>0.05）;（4）There were no significant differences in VAS score,ODI score and anterior vertebral height of the patients in two groups（P>0.05）.（5）The VAS score of 48 hours,3 months,6 months after surgery was lower than that before surgery,and the difference was statistically significant（P<0.05）;The VAS score of 48hours,3 months,and 6 months after surgery was lower in the combined group Compared with the surgery group,and the difference was statistically significant（P<0.05）;（6）There was no significant difference in the height of the anterior vertebral margin between the two groups of patients before operation and 48hours after operation（P>0.05）;the height of the anterior vertebral edge of the patients was compared between the combined group before surgery,48 hours after surgery and 6 months after surgery,and there was no significant difference（P>0.05）;the height of the anterior vertebral edge of the patients in the operation group at 48 hours after operation was not significantly different from that before operation（P>0.05）;There was a significant difference,compared the height of the diseased vertebral edge at 6 months after surgery with at 48 hours after surgery between the operation group,and the difference was statistically significant（P<0.05）;the height of the anterior margin of the diseased vertebrae in the combined group was higher than that in the surgical group at 6 months after the operation,and the difference was statistically significant（P<0.05）;（7）Postoperative radiographic examination of 79 vertebrae in the surgery group revealed 12 vertebrae with bone cement leakage,with a leakage rate of 15.19%.In the combined group,postoperative radiological examination of 73 vertebrae revealed 8 vertebrae with bone cement leakage,the leakage rate was 10.96%,and there was no significant difference in the type of leakage and the leakage rate between the two groups of patients（P>0.05）;（8）During the follow-up period,there were 5 new vertebral metastases in the operation group and no new vertebral metastases in the combined group.The survival rate of patients in the combination group was higher than that in the surgery group,and the difference was statistically significant（P<0.05）.Conclusion:Compared with using PVP alone,PVP combined with zoledronic acid for the treatment of malignant tumor thoracolumbar metastasis not only signifi-cantly relieve patients’thoracolumbar back pain,and improve the quality of life of patients at the end of the disease to a certain extent,but also effectively inhibit the progressive destruction of vertebral bone by tumor cells through zoledronic acid,and maintain the height of the diseased vertebrae for a certain period of time,to enhance the stability of the spine.In addition,this method can relies on the anti-tumor effect of zoledronic acid to inhibit the spread of tumor cells to a certain extent to prevent the metastasis of new vertebral bodies.We believe that the treatment plan with definite clinical efficacy and high safety is worthy of widespread clinical promotion. |
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