一期后路病变椎体切除并内固定手术治疗脊柱肿瘤(附36例报告)  

One stage posterior resection of vertebral body lesions with internal fixation for spinal tumors: 36 cases of report

作　　者：林剑文 王辉[1] 王立楠 李勇爱 李璐尧 施建党[2] 丁惠强[2] 牛宁奎[2] LIN Jianwen;WANG Hui;WANG Linan;LI Yongai;LI Luyao;SHI Jiandang;DING Huiqiang;NIU Ningkui(Ningxia Medical University,Yinchuang 750004,China)

机构地区：[1]宁夏医科大学,银川750004 [2]宁夏医科大学总医院

出　　处：《山东医药》2019年第27期29-32,共4页Shandong Medical Journal

基　　金：宁夏医科大学青年骨干人才培育计划项目(30230103),宁夏医科大学国内一流建设学科临床医学资助项目(NXYLXK2017A05)

摘　　要：目的观察一期后路病变椎体切除并内固定手术治疗脊柱肿瘤的临床疗效.方法36例脊柱肿瘤患者,其中原发肿瘤22例、转移癌14例,均行一期后路手术病变椎体切除并内固定手术治疗,记录患者手术时间、术中出血量、术中输血量、住院时间、术中及术后并发症发生情况,分别于手术前后采用视觉模拟(VAS)评分、日常生活能力量表(ADL)评估原发肿瘤及转移癌患者疼痛及生活能力,对患者进行随访观察其预后情况.结果36例患者中7例行病变椎体完全切除+钛网支撑内固定术,29例行病变椎体部分切除+后路椎弓根钉内固定术.患者手术时间2~8(3.81±0.47)h,术中出血量200~6200(937.5±377.54)mL,术中输血量0~4800(748.61±326.74)mL,住院时间8~49(19.3±3.13)d,术中发生失血性休克、硬膜破裂、胸膜破裂各1例.术前原发肿瘤、转移癌患者VAS评分分别为(6.68±1.25)、(6.93±1.64)分,术后分别为(3.27±0.55)、(3.36±1.91)分,与术前比较,术后原发肿瘤、转移癌患者VAS评分均降低(P均<0.05);术前原发肿瘤、转移癌患者ADL评分分别为(91.36±19.22)、(73.57±28.78)分,术后分别为(96.36±15.97)、(63.21±35.12)分.36例患者中位生存期为15个月,原发肿瘤、转移癌患者中位生存期分别为19.5、13.5个月.36例患者中1例患者术后出现切口感染及钉棒断裂行二次手术;5例肿瘤复发而死亡;3例因肿瘤复发而瘫痪;1例肿瘤复发后再次手术治疗.结论一期后路病变椎体切除并内固定手术治疗脊柱肿瘤临床效果较好.Objective To observe the clinical effect of one stage posterior resection of vertebral body lesions with internal fixation for spinal tumors.Methods Among 36 cases of spinal tumors,22 were primary tumors and 14 were metastatic tumors.All patients underwent one stage posterior resection with internal fixation,then we recorded their operative time,intraoperative blood loss,intraoperative blood transfusion,hospital stay,intraoperative and postoperative complications.Visual analogue scale(VAS)and daily living ability scale(ADL)were used to evaluate the pain and living ability of patients with primary tumor and metastatic cancer before and after surgery,respectively,and the patients were followed up to observe their prognosis.Results Among 36 patients,7 patients underwent total resection of the diseased vertebral body with titanium mesh supporting internal fixation,and 29 patients underwent partial resection of the diseased vertebral body with posterior pedicle screw internal fixation.The duration of operation was 2-8(3.81±0.47)h,intraoperative blood loss was 200-6 200(937.5±377.54)mL,intraoperative blood transfusion was 0-4 800(748.61±326.74)mL,and hospital stay was 849(19.3±3.13)d,with hemorrhagic shock,dural rupture and pleural rupture occurring in 1 case each.Before surgery,VAS scores of patients with primary tumor and metastatic cancer were 6.68±1.25 and(6.93±1.64),respectively;after surgery,the scores were 3.27±0.55 and 3.36±1.91,respectively.Compared with the preoperative results,VAS scores of patients with primary tumor and metastatic cancer decreased after operation(all P<0.05).Before surgery,the ADL scores of patients with primary tumor and metastatic cancer were 91.36±19.22 and 73.57±28.78,respectively;after surgery,the scores were 96.36±15.97 and 63.21±35.12,respectively.The median survival time of 36 patients was 15 months,19.5 months for primary tumor and 13.5 months for metastatic cancer,respectively.Among 36 patients,1 patient had incision infection and nail rod fracture after surgery and r

关 键 词：脊柱肿瘤 椎体切除术 椎弓根内固定术 

分 类 号：R738.1[医药卫生—肿瘤] R687.3[医药卫生—临床医学]