【摘要】 目的:探讨脊柱转移瘤患者的手术切除与脊柱稳定性重建的适应证与效果。方法:2003年4月至2008年4月,收治了脊柱转移癌患者32例。肿瘤转移部位:胸椎转移22例,腰椎转移7例,颈椎转移3例。男性13例,女性19例。出现神经系统受损者27例,其中完全瘫痪者7例,不完全瘫痪者20例。全组患者均做了椎体切除、内固定术或后路椎板切除、椎管减压内固定术或前后路联合行360°脊椎切除固定一期重建脊柱稳定性。观察术后局部疼痛缓解,神经功能恢复及脊柱稳定性情况。结果:随访时间为6~60个月,32例患者中,30例术后痛疼得到缓解。27例有神经功能损害的患者中,25例术后麻痹症状改善。3例完全瘫痪的患者中,2例在减压术后ASIA分级提高了1~2个等级。术后影像学提示脊柱序列和椎间高度恢复。术后存活1年以上的患者22例,约占患者总数的69%。结论:外科切除与重建治疗转移癌所致椎体塌陷或不稳定造成严重的神经损害或机械性脊柱痛疼的外科疗效肯定,能够增加脊椎稳定性,提高生存质量。更多还原

【Abstract】 Objective:Evaluation of the indications and results from surgical resection and reconstruction following the treatment of metastatic spinal tumors.Methods:A retrospective analysis was performed in 32(19 women and 13 men)patients with spinal metastasis underwent surgical treatment between April 2003 and April 2008.The thoracic vertebra was involved in 22 of them,lumbar vertebra in 7,and cervical region in 3.Among 27 of the 32 patients who had neurological dysfunctions,7 patients were completely paralyzed and 20 cases were incompletely paralyzed.All patients in this group had performed surgical treatment by anterior en-bloc or partial resection,decompression and reconstruction with interal fixation of the spine;or by laminectomy and reconstruction with internal fixation;or by anterior-posterior en-bloc resection and reconstruction with interal fixation.Relief of the pain,the function of spinal cord or nerve,and stability of vertebrae were monitored.Results:The follow-up ranged from 6 to 60 months.Pain relief was obtained in 30 of 32 patients(93.8%) and good neurological improvement was obtained in25 of the 27 patients.Among 3 completely paralyzed patients,2 patients experienced an improvement of neurological function from ASIA grade A or B to C or D after decompression.Postoperative radiological evaluation revealed that spinal segments height and normal spinal sequence were restored.The over-all one-year survival rate was 69%(22 cases).Conclusion:Surgical resection and reconstruction for spinal metastasis which lead to vertebra collapsed and unstable is possible to alleviate paralysis and pain from collapse and instability of spine and re-establish the stabilization of spine and improve the quality of life.更多还原