开放微波消融联合椎体成形和钉棒系统内固定治疗胸腰椎转移瘤

目的:探讨开放微波消融联合椎体成形、钉棒系统内固定在胸腰椎转移性肿瘤治疗中的初步临床效果。方法:对2014年1月至2016年1月收治的12例胸腰椎转移癌行开放微波消融联合椎体成形、钉棒系统内固定治疗的患者进行回顾性分析,其中男6例,女6例;年龄30～75岁,平均55.6岁。转移癌类型:肺转移癌5例,乳腺转移癌2例,甲状腺转移癌2例,肾转移癌2例,肝转移癌1例。转移部位:胸椎转移癌7例,腰椎转移癌5例。Tomita预后评分主要集中在3～6分。脊髓神经功能按ASIA分级:C级3例,D级1例,E级8例。术前的VAS评分为8.3±0.4,术后1、3、6个月以及末次随访时采用视觉模拟评分(visual analogue scale,VAS)评价临床效果。结果:12例患者手术出血量500～2 050 ml,平均850 ml。手术时间3.5～5.5 h,平均4.5 h。术中无神经损伤病例。术后发生脑脊液漏3例,经保守治疗后自愈。切口浅表感染2例,经换药后愈合。肺部感染1例。无深部感染、下肢血栓等并发症。术后12例患者均获得随访,时间9～40个月,平均28.6个月。临床症状均有明显改善,下肢运动功能不同程度的恢复,ASIA分级2例C级恢复至D级,1例C级恢复不明显,1例D级恢复至E级。1例患者术后10个月死于原发性肝癌。随访期间1例患者局部肿瘤复发。术后第1、3、6个月以及末次随访时VAS评分分别为2.7±0.6、2.5±0.4、2.6±0.5、2.5±0.5,与术前比较明显改善(P0.05)。结论:开放微波消融联合椎体成形、钉棒系统内固定治疗胸腰椎转移瘤效果肯定,术中出血量较少、手术时间较短、术后疼痛缓解明显、肿瘤复发率低。

Treatment of spine metastases by open decompression,microwave ablation combined with open vertebroplasty and pedicle screw rod system

Objective: To evaluate the preliminary clinical effective of open decompression,microwave ablation combined with open vertebroplasty and pedicle screw rod system in the treatment of spine metastases.Methods: The clinical data of 12 patients with spine metastases were retrospectively analyzed,they were treated with open decompression,microwave ablation combined with open vertebroplasty and pedicle screw rod system between January 2014 and January 2016. Six males and 6 females were included,aged from 30 to 75 years old with an average of 55.6 years. There were 5 cases with spine metastases from lung cancer,2 from breast cancer,2 from thyroid cancer,2 from renal cancer and 1 from liver cancer. Seven cases were thoracic metastases and 5 cases were lumbar metastases. Tomita score were mainly arranging from 3 to 6 points. According to ASIA neurologic grading system,3 patients were grade C,1 was grade D,8 were grade E. Preoperative VAS score was 8.3±0.4. VAS was used to evaluate the clinical effect at 1,3,6 months after operation and final follow-up.Results: All operations were successful and the amount of blood loss during surgery was 500 to 2 050 ml(average of 850 ml),operation time was 3.5 to 5.5 h (average of 4.5 h). There was no nerve root injury during surgery. Cerebrospinal fluid leakage occurred in 3 cases after surgery,which were healed after conservative treatment. Superficial infection of the incision occurred in 2 cases,which were healed after dressing change. There was one case of pulmonary infection. No deep infection,lower limb thrombosis or other complications were found. All 12 patients were followed up for 9-40 months with an average of 28.6 months. The clinical symptoms of all patients were significantly improved,and the motor function of the lower limbs was recovered to varying degrees. According to ASIA grade,2 cases of grade C were improved to grade B;1 case of grade C did not recover significantly;1 case of grade D was improved to grade E. One patient died of primary liver cancer 10 months after surgery. Local tumor recurrence occurred in 1 patient during follow-up period. The VAS scores were 2.7±0.6,2.5±0.4,2.6±0.5,and 2.5±0.5 at 1,3,6 months after surgery and at final follow-up,which were significantly improved compared with the score before surgery(P<0.05).Conclusion: Open decompression,microwave ablation combined with open vertebroplasty and pedicle screw rod system in the treatment of spine metastases show some effects,with less intraoperative blood loss,shorter operation time,significant postoperative pain relief,and low tumor recurrence rate.