胸椎转移瘤硬膜外脊髓压迫症后路减压内固定术生存预后因素分析  

A survival prognostic factor analysis of decompression and internal fixation of epidural spinal cord compression following spinal metastases

作　　者：蒋伟刚[1] 刘耀升[1] 汤传昊[2] 杨绍新[2] 周诗国[3] 刘蜀彬[1] 

机构地区：[1]安徽医科大学解放军307临床学院骨科,合肥230032 [2]安徽医科大学解放军307临床学院肺部肿瘤内科,合肥230032 [3]首都医科大学附属北京友谊医院统计室,北京100050

出　　处：《中国骨与关节杂志》2016年第4期284-289,共6页Chinese Journal of Bone and Joint

基　　金：北京市科委首都临床特色课题(z131107002213052)

摘　　要：目的探讨影响脊柱转移瘤硬膜外脊髓压迫症（metastatic epidural spinal cord compression,MESCC）后路减压内固定术的生存预后因素。方法选择2006年1月至2014年12月于解放军307医院骨科接受后路减压内固定术的胸椎MESCC患者72例。收集每例患者性别、年龄、术前美国东部肿瘤协作组（Eastern cooperative oncology group,ECOG）评分、Tokuhashi评分（包括原发肿瘤特点、术前卡氏评分、内脏转移、脊柱外骨转移、脊柱转移瘤数目和Frankel分级）、确诊原发肿瘤和脊柱转移的间隔期、运动障碍出现的时间、受累椎体分布、连续性、病理性骨折、术后行走状态和术后辅助放化疗等数据。运用单因素KaplanMeier法分析各暴露因素组的生存状况并绘制生存曲线,采用多因素Cox比例风险模型筛选胸椎MESCC后路减压内固定术独立的生存预后因素。结果随访结束时,72例中62例死亡,10例仍存活,中位生存期7.45（0.3~91.9）个月。5例（7%）术后1个月内死亡,47例（65%）术后1年内死亡,55例（76%）术后2年内死亡。单因素分析显示,年龄〈65岁、术前ECOG评分〈2分、Tokuhashi评分〉8分、确诊原发肿瘤和脊柱转移的间隔期〈24个月、术后可行走和术后辅助放化疗的MESCC患者生存期均明显延长（P〈0.05）。多因素Cox比例风险模型分析显示Tokuhashi评分、年龄、和术后行走能力是影响MESCC减压内固定术后生存的独立预后因素。结论 Tokuhashi评分能很好地反映MESCC患者的生存预后情况,同时年龄、术后行走能力也是影响胸椎转移瘤MESCC后路减压内固定术后生存的独立预后因素。Objective To explore the survival prognostic factors of posterior decompression and internal fixation for spinal metastases epidural spinal cord compression（ MESCC）. Methods From January 2006 to December 2014, 72 MESCC patients with thoracic vertebra metastases received posterior decompression and internal fixation in the PLA 307 th hospital. Data were collected, including gender, age, preoperative eastern cooperative oncology group（ ECOG）, Tokuhashi score（ primary tumor, preoperative KPS score, visceral metastasis, extraspinal bone metastases, number of spinal metastases and Frankel grade）, the time interval of the diagnosis of the primary tumor and spinal metastasis, the time of dyskinesia occurrence, distribution, continuity, pathological fracture of the affected vertebral body, postoperative adjuvant radiotherapy, chemotherapy and postoperative ambulatory state. etc. Using single-factor Kaplan-Meier analysis survival conditions of the exposure group to draw a survival curve. Using multi-factor Cox proportional hazards model to screen the independent prognostic factors of the posterior decompression and the internal fixation in the thoracic MESCC. Results At the end of the follow-up of 72 cases, 62 cases died and 10 cases were alive. The median survival period was 7.45 months（ range： 0.3- 91.9 months）. Five cases（ 7%） died within 1 month after the surgery, 47 cases（ 65%） died within 1 year after the surgery, and 55 cases（ 76%） died within 2 years after the surgery. Single factor analysis showed that ambulation and postoperative adjuvant radiotherapy and chemotherapy prolonged survival period significantly（ P 0.05） when age 65, preoperative ECOG 2 points, Tokuhashi score 8 points, interval of diagnosis of the primary tumor and spinal metastasis 24 months. Multi-factor Cox proportional hazards model showed Tokuhashi score, age, and ability of postoperative ambulation were independent survival prognostic factors of the decompression and internal fixation for MESCC. Conclusions Ou

关 键 词：骨肿瘤 胸椎 脊髓压迫症 减压术 外科 预后 

分 类 号：R738.1[医药卫生—肿瘤]