手术联合椎体成形术治疗多发性脊柱肿瘤

目的探讨外科手术联合椎体成形术治疗多发性脊柱肿瘤的方法、疗效及并发症。方法2001年2月至2003年11月,采用手术联合椎体成形术治疗包括转移瘤、多发性骨髓瘤和淋巴瘤等在内的多发性脊柱肿瘤患者20例,男性13例,女性7例。病变累及2个脊椎节段者5例,3～4个节段者11例,5个或以上节段者4例。所有患者均存在神经系统损害和严重疼痛,术前Tomita评分,平均7．2分(3～9分)。结果20例患者中17例(85％)术后疼痛得到缓解,12例有神经功能损害的患者中,10例术后麻痹症状改善。术前Frankel分级为B级的患者1例术后改善为C级;1例术前Frankel A级的患者术后无明显变化。椎体成形术的并发症主要与骨水泥渗漏有关：硬膜外少量渗漏2例3椎,椎旁渗漏2例2椎,沿椎旁静脉渗漏和椎问盘内渗漏各1例。结论选择适当病例,对多发性脊柱肿瘤病例采用外科手术联合椎体成形术以及综合其他治疗方法,可以更好的缓解疼痛,改善神经症状,提高生存质量。

The surgical palliation of operation combined with vertebroplasty for multiple spinal neoplasm

OBJECTIVE: To discuss the effect and complication of spinal operation combined with vertebroplasty in treating for multiple spinal neoplasm. METHODS: During the last two years, 20 patients (13 male and 7 female) with multiple spinal neoplasm including metastases, multiple myeloma and lymphoma were treated by operation combined with vertebroplasty, 2 vertebral body segments were involved in 5 cases, 3 to 4 vertebral body segments were involved in 11 cases, more than 5 segments were involved in other 4 cases. Neurological function deficit and severe pain were seen in all the cases. Patients were evaluated by Tomita prognostic scoring system before the operation; The average point was 7.2 (from 3 to 9 points). RESULTS: The pain relief rate was 85% (17/20), and neurological recovery was found in 10 out of 12 patients who had neurological deficit. According to the system of Frankel and neurological function, 1 patient recovered from grade B to grade C after the operation, and there was no change in another patients who was evaluated as grade A before the operation. The main complication of vertebroplasty was leakage of PMMA. Six patients had leakage of PMMA into adjacent structures in this series. CONCLUSIONS: Better results of pain relief and neurological function recovery and living quality can be achieved by surgical palliation of operation combined with vertebroplasty for multiple spinal neoplasm.