单一后路肿瘤清除、双钛笼重建治疗腰椎转移癌的临床报告  

A Clinical Report of Total Resection and Double Titanium Cage Reconstruction for Lumbar Spinal Metastases Via a Single Posterior Approach

作　　者：刘帅[1] 李正维[1] 冯大鹏[1] 

机构地区：[1]大连医科大学附属第二医院脊柱外科,辽宁大连116023

出　　处：《实用骨科杂志》2017年第4期293-296,300,共5页Journal of Practical Orthopaedics

摘　　要：目的本研究旨在探讨单一后路肿瘤清除(piecemeal total resection,PTR)、双钛笼重建技术治疗腰椎转移癌的临床疗效。方法前瞻性地选取我院2014年1月至2016年1月符合纳入标准的腰椎转移癌患者,共11例患者符合标准。全部11例患者均采用单一后路肿瘤清除、双钛笼重建技术进行治疗,术后辅助放化疗以控制全身及局部肿瘤。通过分析对比11例患者手术前后VAS评分及ASIA损伤分级、有无肿瘤复发及内固定失败,评价该术式的临床疗效及安全性。结果全部患者术后局部及下肢放射性疼痛明显缓解。11例患者中有9例(81.8%)患者神经功能得到改善,2例(18.2%)患者ASIA损伤分级保持在术前水平。手术平均时间5.7h,术中平均出血量2 100mL。术后随访5~16个月,平均10个月。期间3例患者死亡,1例患者肿瘤复发。所有11例患者术后均无硬脊膜损伤、脑脊液漏、血管损伤及切口感染等常见并发症发生,随访期间未见内固定松动、断裂、钛笼脱出及椎间高度丢失。结论对于预计生存期短(小于1年)、预后不佳的腰椎转移癌患者,单一后路肿瘤清除、双钛笼重建技术可以作为一种有效可行的手术治疗方式。Objective To evaluate the clinical effects of total resection and double titanium cage reconstruction on patients with lumbar spinal metastases.Methods According to the inclusion criteria,we prospectively selected 11 pa- tients with lumbar spinal metastases of our hospital from January 2014 to January 2016.Ali patients underwent a total recection via a single posterior approach and double titanium cage reconstruction meanwhile adjuvant chemoradiothera- py was performed to prevent systemic and local tumors after surgery. VAS score, ASIA impairment scale, status of tumor relapse and the success of internal fixation were analyzed to assess the clinical effects and security of our surgical method.Results Local pain or radicular leg pain was relieved for all patients postoperatively.Significant improvements in neurological function were achieved in 9 patients （81.8 %）, while 2 patients received a preoperative ASIA impairment scale.The mean operation time was 5.7 h,with an average blood loss of 2 100 mL.Follow-up time lasted 5 to 16 months （Mean： 10 months） during which three patients died of the disease and one patient suffered local recurrence. None of the 11 patients suffered major postoperative complications such as dural injury,cerebrospinal fluid leakage,vascular in- jury, wound infection and other complications.And no instrumentation failure, titanium cage prolapse and loss of inter- vertebral height during the follow-up period.Conclusion The total resection and double titanium cage reconstruction via a single posterior approach is feasible,safe and effective for special selected cases with poor-prognosis lumbar spinal metastases and less than 1 year of survival.

关 键 词：腰椎 脊柱转移癌 单一后路 双钛笼 全脊椎分块切除 

分 类 号：R738.1[医药卫生—肿瘤]