腰骶部转移性肿瘤的外科治疗  

The Surgical Treatment of the Lumbosacral Metastic Tumor

作　　者：赵锡江[1] 齐新生[1] 

机构地区：[1]无锡市第四人民医院骨科,江苏无锡214062

出　　处：《实用骨科杂志》2014年第6期492-494,共3页Journal of Practical Orthopaedics

摘　　要：目的：探讨腰骶部转移瘤外科治疗的效果。方法2009年9月至2012年12月共有26例腰骶部转移性肿瘤患者接受手术治疗。肺癌转移9例，直肠癌转移3例，乳腺癌转移7例，肝癌转移4例，不明原因转移性肿瘤3例。其中有腰骶部疼痛和/或下肢疼痛者23例，有骶髂关节不稳、活动时疼痛加重者20例，术前15例出现马鞍区感觉减退，排尿困难或便秘，部分下肢活动及感觉障碍。结果2例术后出现脑脊液漏，3例术后切口感染及延期愈合，26例患者中有21例患者术后疼痛明显缓解。疼痛术前数字评分量表评分平均8.1分（4～9分），术后为2.1分（0～4分），与术前比较差异有统计学意义（ P﹤0.05）。随访期间未出现钉棒断裂情况。术前15例有神经功能损害的患者中，12例术后症状改善，3例术后膀胱、直肠功能无改善，总的术后症状缓解率为80％，半数患者能正常从事一般学习和工作。结论依据腰骶椎转移性肿瘤对椎体破坏程度的不同使用不同的后路脊柱-骨盆固定融合术，手术设计更灵活，固定更加牢固，能有效解决脊柱和骨盆的稳定性重建这一治疗中的难点，取得了较满意的临床治疗效果。Objective Toinvestigatetheefficacyofsurgicaltreatmentoflumbosacralmetastictumor.Methods Between September 2009 and December 2012,twenty-six patients with metastatic lumbosacral tumors treated in our department were studied retrospectively. There were metastasis of lung cancer in 9 cases;metastasis of rectal cancer 3 cases,breast cancer me-tastasis in 7 cases,liver metastasis,in 4 cases of metastatic tumors of undefined in 3 cases. Twenty-three patients had pain at lumbosacral region and/or lower limbs,of which twenty patients felt pain aggravated while ambulating. Saddle area hypoesthesia occurredin15patientswithdysuriaorconstipation,partoflowerextremityactivityandsensorydysfunction.Results Thelum-bosacral pain were alleviated significantly（21/26）,cerebrospinal fluid leakage in 2 cases,wound infection and delayed healing in 3 cases. NRS scores was 7. 4（4～9）before operation and was 2. 4（0～4）after operatio,there was significant difference compared with that before operation（P﹤0. 05）. No screw or rod fracture was found in the follow-up period. The neurological function were improved to some degrees（12/15）. However bladder and rectum dysfunction and sexual dysfunction were ob-served in 3 patients. The total postoperative symptom relief rate was 80%,half of the patients can be normal in daily learning andworking.Conclusion Thesurgicaltreatmentoflumbosacralmetastasesdependsonthetumortype,locationwithinspine and damage degree of vertebral. Different posterior spinal-pelvic fixation fusion are effective means of achieving stabilization, providing significant pain relief and preserving ambulatory capacity.

关 键 词：腰椎 骶椎 肿瘤转移 骨科手术方法 治疗结果 

分 类 号：R738.1[医药卫生—肿瘤]