胸腰椎转移瘤后路手术方式选择及临床疗效分析  

POSTERIOR SURGICAL STRATEGY OFR THE TREATMENT OF THORACOLUMBAR METASTASES AND ITS CLINNICAL EFFICACY

作　　者：孙越 王海瑞[1] 刘斌[1] 张连生[1] 王飞[1] SUN Yue;WANG Hai-rui;LIV Bin(People's Hospital Affiliated to Inner Mongolia Medical University,Huhhot 010020 China)

机构地区：[1]内蒙古医科大学附属人民医院骨科,内蒙古呼和浩特010020

出　　处：《疾病监测与控制》2021年第5期346-351,共6页Journal of Diseases Monitor and Control

基　　金：内蒙古自治区科技厅技术攻关项目(2019GG108)。

摘　　要：目的:探讨胸腰椎转移瘤后路手术方式的选择,分析比较两种不同后路手术方式选择的适应证和临床疗效。方法:选择2011-07~2017-10,60例接受后路手术治疗胸腰椎转移瘤的病人进行回顾性分析,男性32例,女性28例,平均年龄60.7岁(39~77岁),胸椎35例,腰椎25例,共90个椎体。所有病人均具有严重的胸或腰部疼痛,不同程度的椎体压缩骨折脊柱不稳和(或)脊髓压迫。均具备手术指征,根据手术方式分为两组,A组42例病人,行单纯后路椎管减压、骨水泥椎体成形钉棒系统内固定术,B组18例病人,行单纯后路椎体次全切全钛网置换钉棒系统内固定术。比较两组病人手术时间、术中出血量、术后并发症、根据VAS评分评估病人术后第3d的疼痛缓解情况、根据Frankel分级评估病人在术后2周时的神经功能恢复情况、根据KPS评分评估病人术后2周时的功能状态改善情况、根据ECOG评分评价其活动状态等。术后每3个月随访一次,行X光片,均进行VAS评分、Frankel分级、KPS评分、ECOG评分。术后病人均接受放疗和(或)化疗及靶向药物治疗。平均随访15个月(3~45个月)。结果:所有病人无术中死亡。A组的手术时间平均210min短于B组310min(P<0.05)、A组平均出血量1050ml少于B组的1800mL(P<0.05);所有病人的VAS评分在术后3d均显著降低,KPS评分分值上升,ECOG评分术后均有改善,两组间疼痛缓解和功能状况改善比较差异无统计学意义(P>0.05)。A组脊髓损伤的病人术后78%Frankel分级得到改善,B组为77%。A组8例发生并发症(19%),B组4例(22%)。A组中位生存时间为14个月,B组为15个月(P>0.05)。结论:两种后路术式均得到了满意的术后效果,对脊柱转移瘤病人采取合适的手术方式,能够有效缓解疼痛,改善神经功能,更好的改善脊柱转移瘤病人的生活质量。Objective:To explore the choice of posterior surgery for thoracolumbar metastases and the indications and clinical effects of two different posterior surgical methods were analyzed and compared.Methods:The 60 patients from July 2011 to October 2017 who underwent posterior surgery for thoracolumbar metastases were analyzed retrospectively.There were 32 males and 28 females,with an average age of 60.7 years(39~77 years),35 thoracic vertebrae and 25 lumbar vertebrae,the total of 90 vertebrae.All patients had severe chest or lumbar pain,varying degrees of vertebral compression fractures,spinal instability and/or spinal cord compression.All had surgical indications.They were divided into two groups according to the mode of operation.42 patients in group A underwent simple posterior spinal canal decompression,bone cement vertebroplasty and screw rod system internal fixation.18 patients in group B underwent simple posterior subtotal vertebrectomy,total titanium mesh replacement and screw rod system internal fixation.They were 32 males and 28 females,and the average age was 60.7 years old(39~77 years old).According to the treatment,35 patients of thoracic metastases and 25 patients of lumbar metastases were included in our study.Totally,90 vertebral bodies were conducted the treatment.All patients suffered severe thoracic or lumbar pain,accompanied by vertebral compression fractures,spinal instability and/or spinal cord repression.They were divided into two groups,grouPA had 42 patients underwent simple posteriorvertebral canal decompression,vertebroplasty and internal fixation,and 18 patients in grouPB were conducted simple posterior corpectomy,titanium mesh replacement and internal fixation.The surgery time,intraoperative bleeding volume and postoperative complications were investigated.All patients'pain scale,neural functional,functional improvement and activity were also observed.The X-ray examination was performed every 3 months after the operation.The VAS scores,Frankel grades,KPS scores and ECOG scoring systems we

关 键 词：脊柱转移瘤 手术方式 疗效分析 

分 类 号：R738.1[医药卫生—肿瘤]