脊柱肿瘤减压固定术后生存与生存质量相关因素  

Factors related to survival and quality of life secondary to decompression and internal fixation for spinal tumors

作　　者：吴瑞丽 杜巧红 李洁心 谢恩[2] WU Rui-li;DU Qiao-hong;LI Jie-xin;XIE En(Central Hospital of Yuncheng City,Yuncheng 044000,China;Honghui Hospital,Xi'an Jiaotong University,Xi'an 710054,China)

机构地区：[1]山西省运城市中心医院,山西运城044000 [2]西安交通大学红会医院,陕西西安710054

出　　处：《中国矫形外科杂志》2022年第8期678-682,共5页Orthopedic Journal of China

基　　金：国家自然科学基金项目(编号:81100930);陕西省社发公关项目(编号:2012k16-09-08)。

摘　　要：[目的]探讨脊柱肿瘤减压固定术后生存与生存质量的相关因素.[方法]回顾性分析2014年7月-2017年7月,本院采用单纯减压或减压固定治疗脊柱肿瘤伴脊髓神经损害153例患者的临床资料,其中,男80例,女73例;年龄17~87岁,平均(61.10±10.71)岁.术后持续随访,观察生存患者的ECOG-PS评级与Frankel指数变化与相关性.采用单项因素比较和Cox回归分析生存相关因素.[结果]153例患者随访3~36个月.术后1个月,78例患者(50.98%)ECOG-PS评分改善,持续时间平均(9.74±0.87)个月.术后1个月76例(49.67%)Frankel指数有所改善,其中71例Frankel指数维持改善持续至术后(10.11±5.17)个月.Spearman相关分析结果表明各时间点ECOG-PS均与Frankel指数呈显著负相关(P<0.05).153例患者中,术后12个月生存121例,占79.08%;死亡32例,占20.12%.生存组的乳腺癌占比、Tokuhashi修正评分、脊椎外骨转移数量、脊椎受累数量均显著低于死亡组(P<0.05),生存组术前ECOG-PS评分和Frankel神经功能评级显著优于死亡组(P<0.05).Cox分析表明,术前Tokuhashi修正评分(HR=9.21,P<0.05)、术前ECOG-PS评分(HR=10.63,P<0.05)、脊椎外骨转移数量(HR=10.45,P<0.05)及脊椎受累数量(HR=2.77,P<0.05)是死亡的独立危险因素.[结论]椎管减压固定术可改善脊柱肿瘤的生存质量.术前Tokuhashi修正评分、ECOG-PS评分、脊椎外骨转移数量和脊椎受累数量是死亡的危险因素.[Objective]To explore the factors related to survival and quality of life after decompression and internal fixation for spinal tumors.[Methods]From July 2014 to July 2017,153 patients,including 80 males and 73 females aged from 17 to 87 years with an average of(61.10±10.71)years,received spinal decompression alone or decompression combined with internal fixation in our hospital for spinal tu・mors complicated with spinal nerve damages.Postoperative follow-up was continued to patient death to observe the change and correlation of ECOG-PS scale and Frankel index of the surviving patients.Univariate comparisons and Cox regression analysis were conducted to search the factors to death.[Results]All the 153 patients in survival were followed up for 3~36 months.The ECOG-PS scores significantly improved in 78 patients(50.98%)one month after surgery,which was maintained for a mean of(9.74±0.87)months,while the Frankel index for neurological function significantly improved in 76 patients(49.67%)at 1 months postoperatively,of them 71 patients had the improvement maintained for(10.11±15.17)months after surgery on an average.The Spearman correlation analysis showed that ECOG-PS was sig・nificantly negatively correlated with Frankel index at all corresponding time points(P<0.05).Among 153 patients,121 patients(79.08%)survived,while 32 patients(20.12%)died at 12 months after surgery.In term of univariate comparison between them,the survival group had significantly lower proportion of breast cancer,Tokuhashi modified score,the number of extramedullary bone metastases and the number of spinal involved site lower than the death group(P<0.05),while the former had significantly better ECOG-PS and Frankel grades than the latter(P<0.05).As results of Cox analysis,the preoperative Tokuhashi modified score(HR=9.21,P<0.05),preoperative ECOG-PS score(HR=10.63,P<0.05),extraspinal bone metastasis(HR=10.45,P<0.05),spinal involved number(HR=2.77,P<0.05)were the independent risk factors for death.[Conclusion]Decompression and interna fixa

关 键 词：脊椎肿瘤 椎管减压固定术 生存质量 相关因素 

分 类 号：R738.1[医药卫生—肿瘤]