胸腰段椎体转移瘤行人工椎体或内固定物置入后的稳定性  

Stability of lumbar vertebra in patients with thoracolumbar vertebral metastases after treated with artificial vertebral placement or internal fixation

作　　者：王东来[1] 冯建刚[1] 李增怀[1] 冯和林[1] 张进明[1] 荀建军[1] 

机构地区：[1]河北医科大学第四医院骨科,河北省石家庄市050010

出　　处：《中国组织工程研究》2013年第30期5575-5580,共6页Chinese Journal of Tissue Engineering Research

基　　金：河北省科技厅支持项目(05276101D-92)~~

摘　　要：背景:脊柱骨转移瘤好发于胸腰段,由于解剖部位复杂给内固定物置入治疗带来难度。目的:评价胸腰段单发椎体转移瘤患者人工椎体或内固定物置入治疗后的稳定性。方法:选取2006年1月至2009年1月河北医科大学第四医院骨科收治的胸腰段单发椎体转移瘤患者16例,男9例,女7例;年龄40-74岁,平均年龄52岁。治疗前Frankel分级:A级2例,B级3例,C级3例,D级5例,E级3例。治疗前所有患者均给予X射线平片检查、核素全身骨扫描检查、CT检查、磁共振检查,以评估患者椎体情况。经胸前入路人工椎体或内固定物置入治疗T11椎体转移瘤,经胸膜外和腹膜外间隙入路人工椎体或内固定物置入治疗T12-L2椎体转移瘤。结果与结论:16例患者均获得随访,随访时间4-32个月,治疗后平均生存时间大于12个月。治疗后Frankel分级:C级3例,D级5例,E级8例。目测类比评分其平均分由治疗前的(6.22±1.31)分降至治疗后的(3.25±0.94)分,两组比较差异有显著性意义(P<0.05)。通过人工椎体或内固定物置入可以恢复脊柱转移瘤患者的椎体稳定性,以达到改善患者症状、提高生活质量的效果。BACKGROUND：Vertebral metastatic tumor often occurs in the thoracolumbar segment, and it is difficult for internal fixation due to the complex anatomical position. OBJECTIVE：To evaluate the stability of lumbar vertebra in the patients with single thoracolumbar vertebral metastases after treated with artificial vertebral placement and internal fixation. METHODS：Sixteen patients （9 male and 7 female） with single thoracolumbar vertebral metastases treated in the Department of Orthopedics, the Fourth Hospital of Hebei Medical University from January 2006 to January 2009 were selected, and the age ranged 40-74 years, averaged 52 years. Before treatment, al the patients were evaluated according to Frankel classification：A grade in two cases, B grade in three cases, C grade in three cases, D grade in five cases, and E grade in three cases. And the vertebral state of patients was detected with X-ray plain film examination, systemic radionuclide bone scanning, CT and MRI. The T11 vertebral metastases were treated with chest approach artificial vertebral placement and internal fixation, and T12-L2 vertebral metastases were treated with artificial vertebral placement and internal fixation via extrapleural and extraperitoneal space approach. RESULTS AND CONCLUSION：Al the 16 patients were fol owed up for 4-32 months, and the average survival time after treatment was 12 months. After treatment, Frankel classification was C grade in three cases, D grade in five cases and E grade in eight cases. The visual analog scale score was decreased from （6.22±1.31） before treatment to （3.25±0.94） after treatment, and there was significant difference between two groups （P〈0.05）. The artificial vertebral placement and internal fixation can restore the stability of lumbar vertebra in the patients with spinal metastases, and thus improving the symptoms and quality of life.

关 键 词：骨关节植入物 骨与关节学术探讨 人工椎体 内固定物 脊柱转移瘤 胸椎 腰椎 稳定性 并发症 省级基金 

分 类 号：R318[医药卫生—生物医学工程]