姑息性手术辅助立体定向放疗治疗胸腰椎转移瘤的临床观察  

Palliation operation assisted with stereotactic radiosurgery for the treatment of metastatic tumor of the thoracolumbar spine

作　　者：关凯[1] 刘川[1] 王俊峰[1] 赵广民[1] 单建林[1] 李放[1] 王亚棣[2] 高军茂[2] 

机构地区：[1]北京军区总医院脊柱外科 [2]北京军区总医院放疗科,100700

出　　处：《颈腰痛杂志》2015年第6期469-474,共6页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨微创椎体成形术及有限切除肿瘤骨水泥填塞内固定术辅助立体定向放疗对脊柱转移性癌患者的治疗效果。方法自2010-01-2014-01,对26例临床确诊的脊柱转移瘤且伴有疼痛、神经压迫症状的患者进行椎体成形术和有限切除骨水泥填塞内固定手术治疗,术后予以立体定向放疗。记录手术出血量、并发症,进行术后2-24个月的随访,随访项目包括VAS、ODI和Frankel分级变化,复查肿瘤控制情况及患者生存时间。结果经统计学比较,术后VAS较术前有显著降低(P<0.05)。经过放疗后,止痛有效率达90%(9/10),渗漏率37.5%,其中1例出现瘫痪,1年内死亡率50%。经统计学比较,术后VAS及ODI较术前有显著降低(P<0.05)。按Frankel分级,7例获得神经功能改善。1年内死亡率50%,2年内死亡率75%。未见内固定失效病例,2例患者局部肿瘤有增长,但因骨水泥阻挡作用未产生硬膜压迫。结论对于脊柱转移瘤患者,椎体成形术及有限切除骨水泥填塞内固定手术能明显缓解疼痛、恢复脊柱稳定性、部分恢复患者神经功能、提高患者生存质量,术后辅助立体定向放射治疗能较好杀灭肿瘤细胞,控制肿瘤复发。Objective To study the minimally invasive vertebral plasty and limited resection of tumor with bone cement implant and internal fixation assisted stereotactic radiosurgery for the treatment of metastatic tumor of the thoracolumbar spine. Methods From January 2010 to Jan- uary 2014, 26 patients with spinal metastatic tumor who accompanied by pain and other symp- toms caused by nerve compression were treated with vertebral plasty and limited resection of tumor with bone cement implant and internal fixation surgery, and followed with stereotactic radiotsurgery postoperation. Tile blood loss, complications, VAS, ODI and change of Frankel classification were recorded. The tumor control and survival time from 2 to 24 months during follow-up were reviewed. Results There was significant difference between the pre- and post- operative VAS score of vertebral plasty group （6.4＋1.26 vs 2.8＋.93,P=0.000）. Pain relieve was 90% （9/10） after radiosurgery, bone cement leakage rate was 37.5%, but only 1 case ap- peared paralysis. The mortality rate was 50% in one year fellow up. The VAS and ODI scores had significant differences between preoperation and postoperation. According to Frankel classifi- cation, 43.75% cases got improvement in nerve function. The mortality rate was 50% within 1 year, and was 75% within two years. There was no internal fixation failure, but two cases ap peared localized tumors recurrence,without epidural pressed because of the bone cement block. Conclusion Vertebral plasty and limited resection of tumor with bone cement implant and internal fixation surgery can relieve pain, restore nerve function, and improve the quality of survival life for patients with spinal metastases. Adding with stereotactic radiosurgery postoperation could kill and control recurrence of tumor.

关 键 词：椎体成形术 骨水泥 骨转移瘤 立体定向放疗 

分 类 号：R738.1[医药卫生—肿瘤]