摘要
目的探讨不同手术方法治疗胸腰椎转移瘤的疗效。方法对25例胸腰椎转移性肿瘤患者,根据术前Tokuhashi评分、肿瘤侵犯的节段、范围和有无神经症状,采取不同的手术方式治疗。术前与术后均对患者的疼痛、脊髓功能进行评估。结果 25例均获得随访,时间5～60个月。患者术后疼痛均较术前减轻或消失,VAS评分:术前平均为(7.2±2.1)分,术后1个月为(2.4±1.5)分,差异有统计学意义(P<0.05)。16例脊髓损伤的患者术后3个月脊髓功能Frankel分级评估:14例分别提高1～2级,2例无改善。骨水泥渗漏6例,未引起临床症状。随访期内未出现骨水泥下沉、松动、椎体塌陷及成角畸。1例术后1年出现原位复发,行二次手术。8例术后6～12个月出现其它节段椎体转移,均带瘤生存,无神经受损症状,未行外科治疗。结论根据患者术前Tokuhashi评分、肿瘤侵犯的节段、范围和有无神经症状采取不同的手术方法治疗,能稳定和重建脊柱稳定性,减轻或缓解疼痛,维持和改善神经功能,从而提高患者生存质量。
Objective To investigate the effect of resection for thoracic and lumbar metastatic tumors.Methods 25 patients with thoracic and lumbar metastatic tumors were treated surgically by different operative pattern according to Tokuhashi score system,location and scope of lesions and neurological symptoms preoperatively.The VAS score and Frankel grade were analyzed to evaluate the surgery efficacy.Results 25 cases were followed up for 5~60 months.Pain relief was obtained in all patients after operation.Preoperative and postoperative VAS score were(7.2±2.1) and(2.4±1.5) respectively(P<0.05).According to the system of Frankel and neurological function: 14 patients improved 1～2 grade and 2 patients remained in the same Frankel grade postoperatively in 16 cases suffered from spinal cord and nerve compromise.6 cases had vertebral bone cement leakage,and none resulted in clinical symptoms.The internal fixation was firmly seated with no bone cement sinking and loosening,no vertebra body collapse and pedicel break during follow-up.A second surgery was performed in 1 patient due to local recurrence after 1 year postoperatively.Other segment vertebral metastases in 8 case after 6 months to 12 months postoperatively,who had not suffered from impaired neurological function,so a second surgery was not given to them.Conclusions Based on Tokuhashi score,location of lesion in the spine and neurological symptoms,different operation pattern can stabilize and reconstruct the spine,relieve pain,maintain or improve the neurological status,thus improve the life qualities in the limited life expectancy patients.
出处
《临床骨科杂志》
2011年第6期612-614,共3页
Journal of Clinical Orthopaedics
关键词
脊柱肿瘤
肿瘤转移
spinal neoplasms
neoplasm metastasis
