微创手术与传统开放手术治疗脊柱转移癌的效果比较  

Comparison of clinical efficacy between minimally invasive surgery and traditional open surgery for spinal metastases

作　　者：张家豪 郭凯 曹佳实 倪祥之 章飞 Zhang Jiahao;Guo Kai;Cao Jiashi;Ni Xiangzhi;Zhang Fei(Department of Orthopaedics,Changzheng Hospital,Navy Medical University y Shanghai 200003,China;Department of Naval Special Medical Center,Navy Medical University^Shanghai 200433,China;Department of Orthopaedics,Ningbo Beilun Orthopedic Hospital,Ningbo 3158009 Zhejiang,China)

机构地区：[1]海军军医大学长征医院骨科,上海200003 [2]海军军医大学海军特色医学中心,上海200433 [3]宁波北仑骨科医院骨科,宁波315800

出　　处：《脊柱外科杂志》2021年第5期302-307,共6页Journal of Spinal Surgery

摘　　要：目的比较微创手术与传统开放手术治疗脊柱转移癌的临床疗效。方法2017年12月—2019年6月,海军军医大学长征医院收治胸腰椎转移癌患者72例,采用随机数字表法分为2组,其中36例采用微创手术治疗(微创组),36例采用传统开放手术治疗(开放组)。采用疼痛视觉模拟量表(VAS)评分评估患者疼痛缓解情况,采用Frankel分级评估患者神经功能恢复情况。比较2组手术时间、术中出血量、术后引流量、术后C反应蛋白(CRP)水平、住院时间及术后并发症发生情况。结果所有手术顺利完成。所有患者随访6~26个月,平均16个月。2组术后各时间点VAS评分、Frankel分级均较术前改善,差异有统计学意义(P<0.05)。微创组术后3、7 d VAS评分低于开放组,差异有统计学意义(P<0.05);2组术后1个月及末次随访时VAS评分、Frankel分级差异均无统计学意义(P>0.05)。2组手术时间、术后CRP水平差异均无统计学意义(P>0.05)。微创组术中出血量、术后引流量、住院时间及术后并发症发生情况均优于开放组,差异有统计学意义(P<0.05)。结论微创手术治疗脊柱转移癌安全有效,可获得与传统开放手术相似的治疗效果,且具有手术创伤小,并发症少,恢复时间短等优点,值得临床推广应用。Objective To compare the clinical efficacy between minimally invasive surgery and traditional open surgery in the treatment of spinal metastases.Methods From December 2017 to June 2019,72 patients with thoracolumbar metastases in Changzheng Hospital of Navy Medical University were randomly divided into 2 groups,36 of whom were treated with minimally invasive surgery(minimally invasive group)and 36 with traditional open surgery(open group).The visual analogue scale(VAS)score was used to evaluate the pain relief,and the Frankel grade was used to evaluate the recovery of neurological function.The operation time,intraoperative blood loss,postoperative drainage volume,postoperative C-reactive protein(CRP)level,hospital stay and postoperative complications were compared between the 2 groups.Results All the operations were successfully completed.All the patients were followed up for 6-26 months,mean 16 months.At each time point after operation,VAS score and Frankel grade of the 2 groups were improved compared with those before operation,and the differences were statistically significant(P<0.05).At postoperative 3 and 7 d,VAS score of the minimally invasive group was lower than that of the open group,and the differences were statistically significant(P<0.05).At postoperative 1 month and the final follow-up,there was no significant difference in VAS score and Frankel grade between the 2 groups(P>0.05).There was no significant difference in operation time and postoperative CRP level between the 2 groups(P>0.05).The intraoperative blood loss,postoperative drainage volume,hospital stay and postoperative complications in the minimally invasive group were better than those in the open group,all with a statistical significance(P<0.05).Conclusions Minimally invasive surgery is safe and effective in the treatment of spinal metastases,which can obtain the same therapeutic effect as traditional open surgery with smaller surgical trauma,less complications,and shorter recovery time,thus being worthy of wider clinical application.

关 键 词：胸椎 腰椎 肿瘤转移 外科手术 微创性 

分 类 号：R738.1[医药卫生—肿瘤]