| Objective:To investigate the selection,curative effect,and prognosis of surgical treatment of spinal metastases,and to summarize the indications of different surgical methods.Methods:114 spinal metastases patients that treated with percutaneous vertebroplasty with 1-125 seed implantation(PVPI)or open surgery(64 patients with PVPI and 50 patients with open surgery)were subjected to propensity score matching analysis in the Department of Orthopaedics,the Third Affiliated Hospital of Kunming Medical University(Yunnan Cancer Hospital),from June 2010 to January 2018.64 patients who underwent PVPI were treated as the treatment group,and 50 patients who underwent open surgery were regarded as the control group,and the propensity score matching analysis was performed on the two groups with a matching capacity of 0.05.The preoperative Tomita score,revised Tokuhashi score,spinal cord injury grade(Frankel),and spinal instability score(SINS),visual analogue scale/score(VAS),Karnofsky score(KPS),intraoperative blood loss,postoperative VAS score(including 1,3,6,12 months after surgery),postoperative KPS score(including 1,3,6,and 12 months after surgery),postoperative complications and long-term survival time were recorded.The statistical data were used to compare the general data and the changes and differences between the two groups of patients.The one-factor Kaplan-Meier log-rank test was used to analyze the influencing factors of long-term survival time of the two groups.The factors influencing the long-term survival time of patients with spinal metastases were analyzed by multivariate Cox regression analysis.Results:1.Intraoperative blood loss:PVPI group 15ml-45ml,average(17.72±8.46)ml,open surgery group:400 ml-4500 ml,mean(1868.75±l033.69)ml,there was a statistically signiflcant difference in intraoperative blood loss between the two groups(P<0.05).2.VAS scores:1)The average VAS score of the preoperative PVPI group was 7.78±1.24,and the average VAS of the open surgery group was 7.90±1.44.There was no significant difference in the preoperative VAS score between the two groups(p>0.05).2)The average VAS score of the PVPI group was 3.72±1.57,and the average VAS score in the open surgery group was 5.13±1.84 in the postoperative 1 month.There was a statistically significant difference in the VAS score between the two groups(p<0.05);3)The average VAS score of the PVPI group was 2.90±1.33 in the postoperative 3 months,and the average VAS score in the open surgery group was 4.56±1.93.There was a statistically significant difference in the VAS score between the two groups(p<0.05).4)The average VAS score of the postoperative 6 months PVPI group was 2.67±1.05,and the average VAS score of the open surgery group was 3.65±1.81.There was a statistically significant difference in the VAS score between the two groups in the postoperative 6 months(p<0.05).5)The average VAS score of the PVPI group was 4.18±1.91,and the average VAS score of the open surgery group was 3.89±1.27 in the postoperative 12 months.There was no statistically significant difference in the VAS scores between the two groups(P>0.05).3.KPS scores:1)preoperative PVPI group was 71.87±9.98,open surgery group was 70.93±8.56,and there was no statistically significant difference in preoperative KPS score between the two groups(P>0.05).2)The average KPS score of PVPI group was 80.00±6.72 and the average KPS score in the open surgery group was 74.69±7.18 in the postoperative 1 month,There was a statistically significant difference between the two groups(P<0.05).3)The average KPS score of the PVPI group was 84.52±6.75,and the average KPS score in the open surgery group was 80.71±7.16 in the postoperative 3 months.There was a statistically significant difference between the two groups(P<0.05).4)The average KPS score of the PVPI group was 84.58±5.88,and the average KPS score in the open surgery group was 84.00±5.98 in the postoperative 6 months.There was no statistically significant difference between the two groups(P>0.05).5)The average KPS score of the PVPI group was 82.50±5.77,and the average KPS score of the open surgery group was 85.56±7.24 in the postoperative 12 months.There was no statistically significant difference between the two groups(P>0.05).4.Complications:There was a statistically significant difference in the incidence of postoperative complications between the PVPI group and the open surgery group(P<0.05).5.Kaplan-Meier single factor analysis showed that there was no significant correlation between gender,age,surgical procedure,comprehensive treatment,surgical site and long-term survival time of patients with spinal metastases(P>0.05).The primary tumor pathological type,Tomita score,and revised Tokuhashi score were the factors affecting the long-term survival time of patients,and there were statistical differences(P<0.05).6.COX multivariate analysis showed that the primary tumor pathological type,Tomita score,and modified Tokuhashi score were independent factors affecting the spinal metastases patients long-term survival time(P<0.05).Conclusion:1.Both PVPI and open surgery can improve the pain symptoms,functional status,and quality of life of patients with spinal metastases2.PVPI and open surgery are equivalent to the treatment of patients with spinal metastases,but PVPI has the advantages of less blood loss,less trauma,and quick recovery after surgery.3.The factors affecting the prognosis of patients with spinal metastases are mainly the pathological type of primary tumor,Tomita score,and revised Tokuhashi score. |
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