摘要
目的 评估微波消融联合经皮骨成形术(POP)治疗扁骨转移瘤的临床疗效、安全性及效价比.方法 纳入2016年1月至2023年1月在中山市人民医院行微波消融联合POP(联合治疗)及单纯POP治疗的57例扁骨转移瘤伴顽固性疼痛患者,其中联合治疗组36例,单纯POP治疗组21例.采用视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)评分、生活质量评价表(QOL)评分定期评价术前及术后不同时期的疗效,并进行两组比较,观察两组相关并发症发生情况.结果 57例手术成功率100％,术后无严重手术并发症发生.随访(4.7±1.3)个月(3.4～7.2个月).术前、术后1 d、1周、1 个月及 3 个月 VAS 评分,联合组分别为(7.39±1.09)、(6.53±1.17)、(1.94±0.70)、(1.11±0.66)、(1.39±0.59)分,单纯 POP 组分别为(7.52±1.01)、(6.81±0.66)、(3.38±0.65)、(2.33±0.56)、(2.52±0.50)分;术后1周联合组VAS评分下降了(5.44±1.32)分,单纯POP组下降了(4.14±0.96)分;术后各随访点VAS评分两组间比较,术后1周(t=-7.62、P＜0.01)、术后1个月(t=-7.28、P＜0.01)、术后3个月(t=-7.58、P＜0.01),差异均有统计学意义.术前、术后1 d、1周、1个月及3个月ODI评分,联合组分别为(44.33±2.91)、(44.08±2.82)、(15.92±3.04)、(14.00±2.39)、(16.08±3.61)分,单纯POP 组分别为(45.67±3.03)、(45.14±2.80)、(22.38±3.09)、(19.76±2.99)、(22.10±3.10)分;术后1周联合组ODI评分平均下降了(28.42±4.23)分,单纯POP组下降了(23.29±4.28);术后各随访点ODI评分两组间比较,术后1周(t=-7.50、P＜0.01)、术后1个月(t=-7.37、P＜0.01)、术后3个月(t=-6.51、P＜0.01),差异均有统计学意义.术前、术后1 d、1周、1个月及3个月QOL评价,联合组分别为(24.69±3.92)、(26.06±3.05)、(38.67±3.00)、(40.25±3.42)、(39.58±3.99)分,单纯 POP 组分别为(24.43±3.53)、(26.76±3.05)、(32.81±2.17)、(33.95±2.68)、(31.19±4.27)分,术后 1 周联合组QOL评分上升了(13.97±4.88)分,单纯POP组上升了(8.38±4.50)分;术后各随访点QOL评分两组间比较,术后1周(t=8.34、P＜0.01)、术后1个月(t=7.56、P＜0.01)、术后3个月(t=7.18、P＜0.01),差异均有统计学意义.联合组的手术费用比单纯POP组平均高10 480.43元.结论 单纯POP和微波消融联合POP治疗扁骨转移瘤均安全有效,可显著缓解疼痛,并提高患者生活质量.与单纯POP相比,联合治疗效果更好,但耗费也更高.
Abstract
Objective To evaluate the clinical efficacy,safety,and potency ratio of microwave ablation(MW A)combined with percutaneous osteoplasty(POP)for the treatment of flat bone metastases.Methods A total of 57 patients with flat bone metastases complicated by intractable pain,who underwent MWA combined with POP(combination therapy)or only POP(pure POP therapy)at the Zhongshan Municipal People's Hospital of China between January 2016 and January 2023,were enrolled in this study.The combination therapy group had 36 patients and the pure POP therapy group had 21 patients.Visual analog scale(VAS),Oswestry Disability Index(ODI),quality of life assessment scale(QOL)were used to evaluate the preoperative and the postoperative different period efficacy,and the results were compared between the two groups.The procedure-related complications in both groups were recorded.Results The technical success rate in the 57 patients was 100％,and no serious postoperative complications occurred.The mean follow-up time was(4.7±1.3)months(range of 3.4-7.2 months).The preoperative and the postoperative one-day,one-week,one-month and 3-month VAS scores in the combination therapy group were(7.39±1.09)points,(6.53±1.17)points,(1.94±0.70)points,(1.11±0.66)points and(1.39±0.59)points respectively,which in the pure POP therapy group were(7.52±1.01)points,(6.81±0.66)points,(3.38±0.65)points,(2.33±0.56)points and(2.52±0.50)points respectively.One week after operation,the VAS scores in the combination therapy group and the pure POP therapy group were decreased by(5.44±1.32)points and(4.14±0.96)points respectively.The differences in the postoperative one-week(t=-7.62,P＜0.01),one-month(t=-7.28,P＜0.01)and 3-month(t=-7.58,P＜0.01)VAS scores between the two groups were statistically significant.The preoperative and the postoperative one-day,one-week,one-month and 3-month ODI scores in the combination therapy group were(44.33±2.91)points,(44.08±2.82)points,(15.92±3.04)points,(14.00±2.39)points and(16.08±3.61)points respectively,which in the pure POP therapy group were(45.67±3.03)points,(45.14±2.80)points,(22.38±3.09)points,(19.76±2.99)points and(22.10±3.10)points respectively.One week after operation,the ODI score in the combination therapy group was decreased by(28.42±4.23)points,which in the pure POP therapy group was decreased by(23.29±4.28)points.The differences in the postoperative one-week(t=-7.50,P＜0.01),one-month(t=-7.37,P＜0.01)and 3-month(t=-6.51,P＜0.01)ODI scores between the two groups were statistically significant.The preoperative and the postoperative one-day,one-week,one-month and 3-month QOL scores in the combination therapy group were(24.69±3.92)points,(26.06±3.05)points,(38.67±3.00)points,(40.25±3.42)points and(39.58±3.99)points respectively,which in the pure POP therapy group were(24.43±3.53)points,(26.76±3.05)points,(32.81±2.17)points,(33.95±2.68)points and(31.19±4.27)points respectively.One week after operation,the QOL score in the combination therapy group was increased by(13.97±4.88)points,which in the pure POP therapy group was increased by(8.38±4.50)points.The differences in the postoperative one-week(t=8.34,P＜0.01),one-month(t=7.56,P＜0.01)and 3-month(t=7.18,P＜0.01)QOL scores between the two groups were statistically significant.The mean operation cost in the combination therapy group was 10 480.43 Chinese yuan,which was higher than that in the pure POP therapy group.Conclusion For the treatment of flat bone metastases,both pure POP therapy and MWA combined with POP therapy are clinically safe and effective,which can significantly relieve pain and improve quality of life.Compared with pure POP therapy,the MWA combined with POP therapy is more effective but its medical cost is more expensive.
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