机构地区:[1]四川省第四人民医院骨二科,四川成都610016 [2]四川大学华西医院骨科,四川成都610041
出 处:《四川医学》2023年第10期1054-1059,共6页Sichuan Medical Journal
摘 要:目的比较椎弓根螺钉内固定术、单纯椎板减压与联合运用病灶微波消融术在胸腰椎转移性肿瘤中的临床疗效。方法回顾性分析2017年1月至2021年5月就诊于四川省第四人民医院收治的45例胸腰椎转移瘤伴病理性骨折的临床资料。按照手术方式分为A组25例采用椎弓根螺钉内固定联合椎板减压术,B组20例在A组的基础上联合运用了病灶微波消融灭活。患者术前均行Tokuhashi评分、Tomita评分。并通过脊柱肿瘤不稳定评分系统(SINS)评估其脊柱稳定性,并运用硬脊膜外脊柱压迫(ESCC)评分系统对脊柱压迫程度进行评价。详细记录了患者术前神经功能障碍的时间、手术持续时间、术中出血量等。并于术前及术后记录所有患者的疼痛VAS评分和SF-36生活质量评分。通过Kaplan-Meier评价系统评估患者的总体生存期。结果45例患者均获得随访,随访时间为5~41个月,中位时间分别为19个月和21个月。术前两组患者Tomita评分、改良Tokuhashi评分、SINS评分、ESCC评分和Frankle分级差异均无统计学意义(P>0.05),两组患者的手术持续时间差异也无统计学意义(P>0.05)。A组患者术中出血量(675.37±87.25)ml高于B组的(549.36±128.14)ml(P<0.05)。两组患者在SF-36生活质量评分和VAS评分方面在术后随访时均较术前明显改善。术后3个月SF-36评分A组(66.39±7.18)分高于B组(75.38±5.95)分,差异有统计学意义(P=0.01)。A组术后1个月和3个月VAS评分分别为(2.80±1.29)分和(2.35±1.04)分,均高于同时刻的B组,差异均有统计学意义(P<0.05)。两组患者术后的脊髓功能均有所改善,但差异无统计学意义(P>0.05)。两组患者的总体生存期差异无统计学意义(P>0.05)。结论在治疗胸腰椎转移性肿瘤时,与传统的单用椎弓根螺钉及椎板减压术相比,加用微波消融灭活后,不会增加手术风险和创伤,在缓解痛处和改善生活治疗方面,具有一定优势。Objective To compare the clinical effects of pedicle screw fixation,decompression with or without microwave ablation in the treatment of thoracolumbar metastases.Methods The clinical data of 45 cases of pathological fractures of thoracic and lumbar metastatic tumor patients treated in the Fourth People's Hospital of Sichuan Province from January 2017 to may 2021 were retrospectively analyzed.Twenty five patients were treated with pedicle screw internal fixation combined with posterior decompression(group A).Twenty patients were treated with microwave ablation combined with laminectomy and pedicle screw fixation(group B).All patients underwent Tokuhashi and Tomita Score before operation.The spinal stability was evaluated by the spinal instability neoplastic score(SINS),and the degree of spinal compression was evaluated by the epidural spinal cord compression(ESCC)score system.The time of preoperative neurological dysfunction,the duration of operation and the amount of intraoperative bleeding were recorded in detail.VAS scores of pain and SF-36 scores of quality of life were recorded before and after operation.Overall survival was assessed by the Kaplan Meier evaluation system.Results All the 45 patients were followed up for 5~41 months,with a median of 19 months and 21 months,respectively.Before operation,there was no significant difference in Tomita score,modified Tokuhashi score,SINS score and ESCC score between the two groups(P>0.05),and there was no significant difference in operation duration between the two groups.(P>0.05);The intraoperative blood loss in group A was(675.37±87.25)ml,higher than(549.36±128.14)ml,the value of which in group B(P<0.05).The SF-36 quality of life score and VAS score of the two groups were significantly improved during postoperative follow-up.The SF-36 score 3 months after operation of group A was(66.39±7.18),and that of group B was(75.38±5.95),the difference was statictically significant(P=0.01).The VAS scores of group A at 1 month and 3 months after operation were(2.80±1.29)
关 键 词:椎弓根螺钉内固定术 胸腰椎转移瘤病理性骨折 椎板减压术 微波消融术
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