【摘要】 目的探讨一期后路病灶切除、360°环脊髓减压、钛网骨水泥重建内固定治疗胸腰椎转移性肿瘤的临床疗效。方法回顾性分析2011-07-2015-03经上述方法治疗的15例胸腰椎转移瘤临床资料。均行一期后路病灶切除、360°环脊髓减压、钛网骨水泥重建内固定术。观察并记录手术时间、术中失血、术后并发症、生存时间;采用VAS评分、SF-36评分、ASIA分级对患者的疼痛程度、生活质量和神经功能进行评价。结果本组患者平均手术时间(297.2±79.1)min,术中出血量(889.3±368.1)ml。术前、术后1个月、末次随访的VAS评分分别为(7.1±1.2)分、(2.1±1.0)分、(2.9±1.5)分,术后各时间点与术前比较,均具有统计学差异(P<0.05)。术前神经功能ASIA分级D级2例,E级13例,末次随访E级12例,D级1例,B级2例。健康调查简表(the MOS item short from health survey,SF-36)评分术前(63.1±7.7)分,术后6个月或末次随访(生存期未达6个月者)(79.8±11.4)分,与术前比较,差异有统计学意义(P<0.05)。患者中位生存时间15个月,围术期死亡1例,术后6个月内死亡3例,术后1年内死亡6例,术后2年内死亡9例,存活2年以上1例。至末次随访,共6例患者存活。结论一期后路病灶切除、360°环脊髓减压、钛网骨水泥重建联合内固定治疗胸腰椎转移性肿瘤,可明显改善患者神经症状和生存质量,同时,可为患者争取获得更多辅助治疗的机会,达到局部病变的中长期控制。更多还原

【Abstract】 Objective To investigate the clinical effects of one-stage tumor excision and circumferential spinal cord decompression using titanium mesh implantation and pedicle screw fixation via a posterior approach for the treatment of thoracolumbar spinal metastasis. Methods We retrospectively reviewed the follow-up data of fifteen patients between July 2011 and March 2015.All of them underwent one-stage tumor excision and circumferential spinal cord decompression using titanium mesh implantation and pedicle screw fixation via a posterior approach. We observed and recorded operation time, blood loss, postoperative complications, pain release and survival time,estimating pain, quality of life and neurological function by VAS score, SF-36 score and ASIA neurological function classification respectively. Results The average operation time was(297.2 ±79.1)min,average blood loss was(889.3±368.1)ml. The VAS score was decreased from(7.1±1.2)preoperation to(2.1±1.0)one month post-operation, which showed significant difference(P<0.05); that at the last follow-up was(2.9±1.5)scores, showed significant difference compared with pre-operation(P<0.05). The ASIA neurological function classification pre-operation was D 2,E 13,that at the last follow-up was E 12,D 1,B 2.The SF-36 score was decreased from(63.1±7.7) pre-operation to(79.8±11.4) six months post-operation, which showed significant difference(P<0.05). The median survival time was 15 months, 1 patient died during the perioperative period,3 cases died in six months post-operation,6 cases died in one year post-operation,9 cases died in two years post-operation,1 case survived more than 2 years. There were 6 cases survived till the last follow-up. Conclusion One-stage tumor excision and circumferential spinal cord decompression with titanium mesh implantation and pedicle screw fixation via a posterior approach is feasible and effective for the management of selected patients with thoracolumbar spinal metastasis, creating more chances for gaining multidisciplinary treatments the time improving quality of life.更多还原