Objective:To study the efficacy and safety of bone-filling mesh container plasty in the treatment of posterior wall fracture of vertebra caused by spinal metastases.Methods:This study is a retrospective analysis of 65 patients with pathological fractures of the vertebra caused by vertebral metastases treated with bone-filling mesh container plasty from January 2015 to December 2019. There were 21 males and 44 females, 70.3±10.8 (46-90) (years). According to primary tumor, there were 25 cases of lung cancer, 14 cases of breast cancer, 11 cases of digestive system cancer, 13 cases of urinary system cancer, 1 case of lymphoma and 1 case of ovarian cancer. In the segment of vertebral metastases, there were 2 cases of T 2 vertebra, 1 case of T 5 vertebra, 1 case of T 6 vertebra, 2 cases of T 8 vertebra, 1 case of T 9 vertebra, 5 cases of T 10 vertebra, 4 cases of T 11 vertebra, 15 cases of T 12 vertebra, 12 cases of L 1 vertebra, 8 cases of L 2 vertebra, 8 cases of L 3 vertebra, 4 cases of L 4 vertebra, and 2 cases of L 5 vertebra. According to the CT images of the patient's vertebra before operation, the area of the damaged posterior wall of the vertebra is measured as s, and the area of the posterior wall of the intact vertebra is measured as S. The ratio of posterior wall damage is calculated as R= s/ S, and the value of R represents the degree of damage to the posterior wall of the vertebra. According to the size of the R value, the patients were divided into four groups, typeⅠ( R≤25%, 21 cases), typeⅡ(25%< R≤50%, 22 cases), typeⅢ (50%< R≤75%, 14 cases), typeⅣ( R>75%, 8 cases). The visual analog scale (VAS), Oswestry disability index (ODI) and activity of daily living (ADL) before and 1 day after surgery, 1 month after surgery, and 3 months after surgery were analyzed and compared to evaluate the efficacy of bone-filling mesh container plasty. Pairwise comparisons were performed to verify whether there is a difference in efficacy, bone cement leakage and postoperative complications. Results:All 65 patients were followed up for 3-6 months, with an average of 3.8 months. The VAS scores before surgery, postoperative day 1, postoperative 1, 3 months were 7.32±0.99, 4.14±1.06, 4.11±0.97, and 4.34±1.11, respectively, with a statistically significant difference ( F=149.20, P<0.001). ODI of preoperative, postoperative day 1, postoperative 1, and 3 months were 69.45%±4.15%, 36.65%±3.72%, 36.84%± 3.38%, 37.78%±3.45%, respectively, with a statistically significant difference ( F=840.88, P<0.001). ADL score of preoperative, postoperative day 1, postoperative 1, and 3 months were 71.31±12.81, 79.85±9.14, 78.92±8.95, and 78.31±8.67, respectively, with a statistically significant difference ( F=149.20, P<0.001). There was no significant difference in VAS, ODI and ADL scores between types I and IV (all P>0.05), but with the increase of R value, the leakage rate of intraspinal bone cement would increase correspondingly. Eleven cases occurred bone cement leakage with the rate of 17%. The leakage rate of type I and II was 0, type III was 7.1% (1/14), and type IV was 37.5% (3/8). All patients did not have systemic complications such as allergies, shock, decreased oxygen saturation, etc., and there were no bleeding, infection, nerve root symptoms or cement insertion syndrome after surgery. Conclusion:Bone-filling mesh container plasty can significantly improve the pain symptoms of patients with spinal metastases and recovery functions. The degree of damage to the posterior vertebra has no effect on the efficacy of the surgery. As the degree of damage to the posterior wall of the vertebra increases, the risk of complications of bone cement leakage in the spinal canal will increase.

目的 探讨BacFuse治疗退行性腰椎滑脱症的临床疗效.方法 分析某医院2015年8月1日-2018年8月31日期间住院接受BacFuse手术治疗的36例退行性腰椎滑脱症的患者,其中男性11例,平均年龄(68.6±7.3)岁,女性25例,平均年龄(67.8±8.3)岁.Ⅰ度滑脱患者30例,Ⅱ度滑脱患者6例;单节段患者27例,双节段患者9例.术后随访时间分别为术后1个月、术后6个月、术后2年,采用视觉模拟评分及Oswestry功能障碍指数进行疗效评估.采用椎间盘后缘高度、椎体滑脱程度、椎间隙活动范围、椎体的过屈角度及椎体的过伸角度进行影像学评估.结果 本组患者的VAS评分由术前的(5.67±0.99)分降至末次随访的(2.19±1.17)分(P<0.001);ODI评分由术前的(32.41±4.09)分降至(11.98±5.60)分(P<0.001);影像学评估PDH由术前的(0.484±0.18)厘米升至术后末次随访的(0.716±0.25)厘米(P<0.001),SD由术前的(6.214±4.30)厘米降至(2.483±3.03)厘米(P<0.001);FA由术前的(4.164±4.79)度降至(3.959±3.88)度(P>0.05);EA由术前的(10.378±4.87)度降至(6.44±4.99)度(P<0.001);ROM由术前的(6.214±4.30)度降至(2.483±3.03)度(P<0.001).结论 对于I度退行性腰椎滑脱的患者,BacFuse棘突间固定融合术是一种可行的治疗方法,能够改善患者症状,并且手术时间短,损伤小,并发症少,可作为退行性腰椎滑脱的阶段治疗方案,从而延缓甚至避免行钉棒手术.

Objective To assess the preoperative and postoperative changes in MRI image and the short-term efficacy of the ISDF with BacFuse covering 3 years. Methods 32 patients who underwent ISDF were involved in this retrospective study. The symptoms assessment including VAS, ODI, and SF-12 were evaluated preoperative and postoperative at 1 year and 3 years. The X-ray was used to measure posterior disk height (PDH), foramina height (FH), foramina width (FW), and MRI was taken to assess the cross-sectional area of dura sac (CSADS), cross-sectional area of canal (CSAC), herniated disc area, ligamentum flavum area. The preoperative ratio of herniated disc area and ligamentum flavum area to CSAC were compared with post-operative ratio. The modified Pfirrmann grade system was used to assess the surgical lumbar disc. Results The symptom indexes were significantly improved after surgery. PDH and FH increased significantly (P < 0.05) after surgery compared with that before surgery, but there was no statistical difference in FW (P > 0.05). CSADS and CSAC increased obviously (P < 0.05), while the area of herniated disc and ligamentum flavum decreased significantly (P < 0.05). The ratio changes showed a significant difference between last follow-up and pre-operation (P < 0.05), but there was no statistical significance in grade changes of surgical disc. Conclusion ISDF with BacFuse could relieve clinical symptoms and expanse the spinal canal area in MRI. During 3-year observation, it could provide continuous traction and maintain the area of spinal canal, so as to partially retract the herniated disc and make it possible to repair the disc.