摘要
目的探讨胸腰椎转移性肿瘤外科治疗的适应证和方法。方法1988年2月～2001年12月,手术治疗胸腰椎转移性肿瘤47例,男29例,女18例;年龄34～75岁,中位年龄58.5岁。肺癌12例、乳腺癌9例、甲状腺癌7例、前列腺癌5例、肝癌和肾癌各4例、胃癌1例、未发现原发灶5例。前路手术31例,前后联合入路全脊椎切除术11例,后路手术5例。术前Frankel分级:A级6例,B级9例,C级12例,D级13例,E级7例。结果术后疼痛消失31例(67.39%),缓解12例(26.09%),无明显缓解3例(6.52%),1例术后3d死亡。41例获得随访,随访时间3个月～6年,平均38.2个月。33例死亡,存活8例。术后Frankel分级:A级2例,B级2例,C级3例,D级13例,E级21例。4例内固定松动,1例断裂。结论胸腰椎转移性肿瘤的治疗根据患者的年龄、全身情况、预期寿命、肿瘤的位置和类型、对各种治疗的敏感性、脊柱的不稳定程度和神经症状综合考虑,手术治疗采用经前路、前后联合入路或后路手术,体现个体化治疗。
Objective To study the indications and methods of surgical treatment for thoracic and lum bar spinal metastases.Methods The study presented a retrospective analysis of 47patients with thoracic and lumbar spinal metastases treated surgically from January1988to December2001.In the group,there were18females and29males,aging from34to75years old with the mean age of 58.5years.In42of 47cases,it is possible to establish the primary focus of the tu mor,there were lung carcinoma in12cases,breast carcinoma in9cases,thyroid gland carcinoma in7cases,prostate carcinoma in5cases,kidney carcinoma in4cases,hepatocarcinoma in4cases and stomach carcinoma in1case.In5of 47cases,primary focus of the le-sion were unable to establish.Of the47cases,31patients underwent anterior tumor re section and instrumen-tation of internal fixation for stabilization,11patients underwent combination of anterior-posterior approach for re section of tumor followed by reconstruction and stabilization,and5patients underwent posterior resec-tion accompanied by stabi lization.Pre-operative Frankel grade was evaluated as grade A6cases,grade B9cases,grade C12cases,grade D13cases and grade E7cases.Results After the opera tion,the pain was re-lieved in31cases(67.39%),recurred in12cases(20.09%)and unchanged in3cases(6.22%).The period of follow-up ranged from3months to6years with a mean of 38.2months.Forty-one of 47patients were fol lowed up,33cases died and8cases sur vived.Postoperative Frankel grade was classified as grade A2cases,B2cases,C3cases,D13cases and E21cases.Conclusion The surgical treatment of thoracic and lumbar spinal metastasis depends on the patient age,general condition,life ex pectancy,history of previous treatment,tumor type,lo cation within spine,sensibility to different treatment,degree of spinal instabilization and neuro-logical deterio ration.Each case must be dealt with on an individual basis in order to adopt the most appropri-ate tech nique in ac complishing the goals of improving quality of life and preserving of improving neu rologi -cal function.There are three approaches for resection of tumors followed by reconstruction and stabilization,in cluding of anterior,simultaneous anterior-posterior and posterior ap proach.[
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2003年第1期28-32,共5页
Chinese Journal of Orthopaedics
关键词
胸腰椎
转移性肿瘤
外科治疗
适应证
手术入路
Thoracic vertebrae
Lumbar vertebrae
Neoplasm metastasis
Orthopedic procedures
Treatment outcome
