【作者】 王东来； 冯建刚；

【Author】 Wang Dong-Lai Feng Jian-Gang Department of Orthopaedics, The fourth hospital of Hebei medical university & Hebei provincial tumor hospital, Shijiazhuang, 050011, China

【机构】 河北医科大学第四医院暨河北省肿瘤医院骨科；

【摘要】 目的:胸椎是脊柱肿瘤最常见的好发部位,胸椎肿瘤所引起的疼痛和脊髓压迫严重影响着患者生活质量,保守治疗效果欠佳。探讨胸椎肿瘤手术治疗的临床效果。方法:回顾性分析2002年3月至2006年1月我院手术治疗胸椎肿瘤患者19例,男性8例,女性11例。平均年龄56．6岁(37—73 岁),其中原发肿瘤8例(多发性骨髓瘤6例,神经源性肿瘤和血管瘤各一例),转移瘤11例(乳腺癌2例,肺癌4例,肾癌2例,贲门癌1例,慢性淋巴细胞白血病1例,膀胱癌1例), 包括椎体单发肿瘤13例(T1 2例,T3 2例,T4 3例,T6 1例,T7 2例,T9 1例,T10 1例,T12 1例),病变累及2 个椎体6例(T2T3,T5T7,T6T9,T7T10,T8T10,T12L1, 各一例),合并脊髓功能损害7例,按Frankel分级法评估: B级3例,C级2例,D级2例。手术方法包括肿瘤切除脊柱内固定重建术(16例)和经皮椎体成形术(3例)。术后根据肿瘤的特点,辅以放化疗或其他治疗。结果:所有患者安全度过围手术期,平均住院时间21天,术后并发症包括肺部感染 2例,不完全霍纳氏综合征2例,术后患者疼痛缓解率为94． 7％,合并脊髓功能损害的患者中,3例恢复正常,2例恢复至 Frankel E级,1例恢复至Frankel D级,1例无效。出院后平均随访时间为18个月,1例失访。术后平均死亡时间为11 个月,死亡的10例患者中,在死亡前出现瘫痪的3例,出现大小便障碍的2例。所有患者在随访过程中没有出现内固定物的松动征象。结论:手术治疗胸椎肿瘤能够明显的缓解患者的疼痛症状,并且有效的治疗和预防截瘫,改善和提高患者的生存质量。同时应根据肿瘤的位置、类型和椎体的破坏程度以及患者的经济能力选择适合的手术方法。更多还原

【Abstract】 Objective: The thoracic vertebrae is the most familiar occurrence part in the spinal tumor, the ache and spinal cords compression affect the sufferer life quantity. In order to treat and prevent spinal cord paralysis, decompression and stabilization should be preformed on the patients .The article is to evaluate the clinical results for patients with thoracic vertebrae tumor treated by means of surgical treatment Methods: From March 2002 to January 2006,19 patients (11 women and 8 men) with thoracic vertebrae tumor had been treated at our department. The average age was 56.6 years old. Of 19 patients, the primary tumor were involved in 8 cases (multiple myeloma in 6 , hemangioma in 1, neurogenic tumor in 1 ),the metastasis tumor were 11 cases (breast cancer in 2,lung cancer in 4,renal carcinoma in 2,cardia cancer in l,chronic lymphocytic leukemia in l,bladder cancer in 1).Among 7 of 19 patients who presented with neurological dysfunction (Frankel grade B in 3, Frankel grade C in 2, Frankel grade D in 2).All the patients were treated by tumor excision and reconstruction of the spinal stability or the percutaneous vertebroplasty (PVP).After the operation , according to the characteristics of the tumor, assist to put chemotherapy or other treatment Results: After the operation, the pain was relieved or recurred in 18 cases(94.7%). Postoperative Frankel grade was classified as grade D 1 case, grade E 2 cases and three patients resumed the normal myodynamia and sense in the patients with neurological dysfunction. The operative complication included the the pneumonia 2 cases and the Homer syndrome 2 cases. The period of follow-up ranged from 5 months to 30 months with a mean of 18 months, 18 of 19 were followed-up, 10 cases died and the average time of death was 11 months after operation. Among the 10 died cases, paralyzed in 3 cases and presented with bowel and bladder dysfunction in 2 cases. There were no internal fixations loosen and breakage in every cases. Conclusion: The surgical operation treatment thoracic vertebrae tumor can alleviate the sufferer’s ache symptom obviously, prevent the paraplegia and improve the patient’ s quality of the daily life. At the same time, the surgical project de- pend on the tumor’s type and location, the degree of spinal instabilization and neurological deterioration, and the patient’ s economic ability.更多还原