第一临床医学院知识库

目的：分别采用PVP联合125I粒子植入法和单纯PVP治疗椎体转移瘤，比较两种方法对局部疗效、疼痛、下肢肌力和体力的影响，以及术后并发症发生率，以期为临床椎体转移瘤的治疗提供更安全有效的方法。

方法：观察2015年7月至2016年7月甘肃省第二人民医院介入肿瘤科符合纳入与排除标准的56例椎体转移瘤患者，以年龄及累计椎体节数进行区组随机化，将研究组与对照组进行匹配，研究组进行的是PVP联合125I粒子植入术治疗法，对照组进行的是单纯PVP治疗法。观察记录各组术后并发症发生率，术前及术后第2天，1周，1、3、6个月的NRS疼痛评分，下肢肌力评分，KPS评分以及术后3个月的局部疗效。使用卡方检验和方差分析比较两组患者各项指标的变化情况及组间差异。

结果：1.PVP联合125I粒子植入组和单纯PVP组术前疼痛程度、下肢肌力分级情况、体力状况和年龄等方面的差异无统计学意义。（P>0.05）2.PVP联合125I粒子植入组和单纯PVP组的客观有效率分别为53.57%和25.00%，疾病控制率分别为92.86%和60.71%，差异有统计学意义(χ2=4.791，P=0.029<0.05；χ2=8.114，P=0.004<0.05)。3.PVP联合125I粒子植入组的术后第2天、1周、1月、3月和6月的疼痛缓解有效率21.43%，100.00%，100.00%，96.15%和100.00%。单纯PVP组的术后第2天、1周、1月、3月和6月的疼痛缓解有效率17.86%，53.57%，67.85%，62.96%和62.50%。在术后1周至6月后，两组患者的疼痛缓解有统计学意义（P<0.05）。4.PVP联合125I粒子植入组的术后第2天、1周、1月、3月和6月的下肢肌力4级和5级所占比例分别为50.00%，92.86%，96.43%，96.15%和100.00%。单纯PVP组的术后第2天、1周、1月、3月和6月的下肢肌力4级和5级所占比例分别为28.57%，50.00%，53.57%，48.15%和54.17%。在术后1周至6月后，PVP联合125I粒子植入组和单纯PVP组不同肌力分级方面的差异存在统计学意义（P<0.05）。5.PVP和125I粒子联合组术前KPS为46.79±12.49，术后第2天、1周、1月、3月和6月的分别为56.43±11.93、65.36±9.22、78.57±12.08、76.15±9.41和71.25±9.92，组内的差异有统计学意义（F=34.299，P=0.000<0.05）。单纯PVP组术前KPS为46.43±11.93，术后第2天、1周、1月、3月和6月的分别为57.50±12.06、63.93±11.33、64.29±11.68、61.48±10.99和57.91±11.79，组内的差异有统计学意义（F=9.038，P=0.000<0.05）。将PVP联合125I粒子植入组和单纯PVP组的KPS评分进行t检验，在术后第2天和1周的差异无统计学意义（P>0.05），在术后的 1月、3月和6月差异有统计学意义（P<0.05）。6.PVP联合125I粒子植入组和单纯PVP组的术后并发症发生率分别为3.57%和7.14%，差别没有显著统计学意义（P=l.00>0.05）。

结论：1.PVP联合125I粒子植入治疗椎体转移瘤，能使疼痛缓解，抗肿瘤的作用增强，体力活动增加和下肢肌力恢复，是一种安全可靠、创伤小、有效的方法。 2. 除术后第2天，PVP联合125I粒子植入治疗椎体转移瘤比单纯PVP术更优。

Objective:To compare the clinical outcomes in local therapeutic efficacy, pain control, muscle strength grades of legs and performance status of percutaneous vertebroplasty (PVP) combined with 125I-seed implantation and percutaneous vertebroplasty for the treatment of metastatic vertebral carcinoma involving the spinal canal. It can provide more effective ways for clinical treatment.

Methods:Fifty-six patients with spinal metastatic tumor admitted to department of tumors intervention in Gansu the second provincial hospital in July 2015 to July 2016 was performed.The study group was with a matched control group by accumulative vertebral segment and age(±three years) .The study group was operated by percutaneous vertebroplasty combined with 125I-seed implantation (n=28). The control group was operated by percutaneous vertebroplasty (PVP) (n=28). The local therapeutic efficacy were recoded 3 months after surgery. both before surgery and 2 days, 1, 3, 6 months after surgery, the pain control, muscle strength grades of legs and performance status were recoded. Then it used ststistic methords to compare the statuses between two groups.

Results:1. There were no deference in age, levels of pain, muscle strength grades of legs, and physical condition between percutaneous vertebroplasty combined with 125I-seed implantation and percutaneous vertebroplasty (P>0.05).2. The ORR of percutaneous vertebroplasty combined with 125I-seed implantation and percutaneous vertebroplasty were 53.57% and 25.00%. The DCR of two groups were 92.86% and 60.71%. The ORR and DCR between two groups had significant difference (P<0.05). 3. After treatment 2 day, 1 week, 1month,3 months and 6 months, the efficiently of pain relief of percutaneous vertebroplasty combined with 125I-seed implantation were 21.43%, 100.00%, 100.00%, 96.15% and 100.00%. The efficiently of pain relief of percutaneous vertebroplasty were 17.86%，53.57%，67.85%，62.96%和62.50%. After treatment 1 week, 1month, 3 months and 6 months, there were significant differences in efficiently of pain relief between two groups.4. After treatment 2day, 1 week, 1month,3 months and 6 months, The proportion of grade 4 and 5 of muscle strength grades were 50.00%，92.86%，96.43%，96.15% and 100.00% in percutaneous vertebroplasty combined with 125I-seed implantation. The proportion of grade 4 and 5 of muscle strength grades were 28.57%，50.00%，53.57%，48.15% and 54.17% in percutaneous vertebroplasty. After treatment 1 week, 1month,3 months and 6 months, The muscle strength grades between two groups had significant difference (P<0.05). 5.The score of KPS in percutaneous vertebroplasty combined with 125I-seed implantation before operating was 46.79±12.49. After treatment 1 day, 1 week, 1month,3 months and 6 months, there were 56.43±11.93、65.36±9.22、78.57±12.08、76.15±9.41 and 71.25±9.92. There was significant difference in group (F=34.299，P=0.000<0.05). The score of KPS in percutaneous vertebroplasty before operating was 46.43±11.93. After treatment 1 day, 1 week, 1month,3 months and 6 months, there were 57.50±12.06、63.93±11.33、64.29±11.68、61.48±10.99 and 57.91±11.79. There was significant difference in group (F=9.038，P=0.000<0.05). Using t-test, After treatment 1month,3 months and 6 months, The score of KPS of two groups had significant difference(P<0.05). 6.The postoperative complication rate of percutaneous vertebroplasty combined with 125I-seed implantation and percutaneous vertebroplasty were 3.57% and 7.14%.There were non-significant difference between two groups (P>0.05).

Conclusions: 1.Percutaneous vertebroplasty combined with 125I-seed implantation is also safe and effective treatment in improving the quality of life and pain relief. 2.Percutaneous vertebroplasty combined with 125I-seed implantation is greater efficacy than percutaneous vertebroplasty.