| Objective:To explore the clinical application and therapeutic effect of percutaneous vertebroplasty combined with local chemotherapy therapy for thoracolumbar metastatic tumor, and to discuss with related problems.Methods:A retrospective study was conducted to review48patients (complete follow-up data) with thoracolumbar metastatic tumor underwent the surjical operation form May2006to June2011in orthopedic of our hospital.Those were set into groups including study group and control group depending on whether local chemotherapy was applied, in which study group including in22patients was treated by open vertebralplasty joint radiofrequency ablation (RFA) and local chemotherapy,the other including in26patients by open vertebralplasty joint radiofrequency ablation.Chemotherapy drugs applied in study group included Table Abriamycin (11cases), Methotrexate (6cases), Lobaplatin (3cases) and Mitomycin (2cases).The primary focus of the tumor of42cases were established, hepatocarcinoma was in9cases, lung carcinoma in8cases, breast cancer in7cases, gastric carcinoma in6cases, colon cancer in4cases, renal carcinoma in4cases, prostate carcinoma in2cases, and bladder cancer in2case.The primary focus of6cases could not be established. The spinal function according to Frankel grade, grade A was in3cases, B in6, C in7, D in17, E in15.There were22cases which were pathological fractures in48cases, study group was in9cases,control group in13cases. The back pain, height of anterior and posterior vertebral body, Cobb angle, bone cement leakage rate, spinal function, local recurrence rate and postoperative survival rate were recorded before and after operation. Results:1There was no significant difference between the two groups for the preoperative pain degree of difference(P>0.05).After one month, the efficiency rate and the complete relief rate of the study group were86.4%and18.2%, respectively, on the other hand, the efficiency rate and the complete relief rate of the control group were61.5%and11.5%, respectively.After six months, the efficiency rate and the complete relief rate of the study group were63.6%and9.0%, respectively, on the other hand, the efficiency rate and the complete relief rate of the control group were53.8%and7.7%, respectively.There was significant difference between the two groups for the postoperative pain degree of difference after one month (P<0.05),while there was no significant difference after six months (P>0.05)2Among9cases combined with pathological fracturethe in the study group,the height of anterior spinal vertebral body increased from (9.1±2.6) mm preoperatively to (22.2±2.5) mm postoperatively; the height of posterior spinal vertebral body increased from (16.2±1.7) mm preoperatively to (22.4±1.6) mm postoperatively; Cobb angle decreased from (25.0±7.9)°preoperatively to (5.8±1.1)°postoperatively.Among13cases combined with pathological fracturethe in the control group,the height of anterior spinal vertebral body increased from (10.7±2.2) mm preoperatively to (21.4±1.2) mm postoperatively; the height of posterior spinal vertebral body increased from (16.3±1.4) mm preoperatively to (21.7±1.2) mm postoperatively; Cobb angle decreased from (24.9±8.2)°preoperatively to (6.7±1.5) postoperatively.There was significant difference above items between before and after operation (P<0.05).But There was no significant difference above items between the study group and the control group (P>0.05)3There were4cases combined with leakage of bone cement in the study group,and there were5cases combined with leakage of bone cement in the control group. There was no significant difference above item between the study group and the control group (P>0.05)4In the study group,13cases of the spinal function had improved in the 15cases who accompanied by spinal nerve dysfunction preoperative. There was no significant difference above item between the study group and the control group (P>0.05)5There were3cases combined with local recurrence in the study group,and there were5cases combined with local recurrence in the control group. There was no significant difference above item between the study group and the control group (P>0.05)6There was no significant difference about postoperative survival rate the between the study group and the control group (P>0.05)Conclusion1Open vertebralplasty joint radiofrequency ablation and local chemotherapy is feasible in clinical practice,and can effectively preserve spinal instability and alleviate the spinal cord symptoms, improve the life quality of patients.The surgical intervention have small trauma and high safty,and is suitable for patients in poor general health,lesions locating in the central and back spinal,multiple vertebral body lesions,shorter life expectancy and not suitable for anterior surgery.2Its short-term effect may be enhanced by adding chemotherapy drugs into bone cement,but its long-term effect of inhibitinng tumor is not significant.It is no influence to the strength and hardness of bone cement by adding chemotherapy drugs of low concentration into bone cement,which cannot increase the risk of leakage of bone cement. When combined with open vertebralplasty and radiofrequency ablation treat thoracolumbar metastatic tumor, local chemotherapy seems not to have significant contribution in spinal stability,local recurrence rate and postoperative survival rate.The clinical value of open vertebralplasty joint radiofrequency ablation and local chemotherapy need to be tested through clinical practice and study in larger scale. |
PDF Full Text Request