开放性椎体成形术治疗胸腰椎转移性肿瘤的临床探讨

目的:探讨开放性椎体成形术在胸腰椎转移性肿瘤治疗中的临床应用和治疗效果。方法:自2003年9月至2009年12月,对21例胸腰椎转移性肿瘤患者施行了后路椎管减压、开放式骨水泥椎体成形联合短节段椎弓根钉固定的手术治疗,其中男14例,女7例;年龄48～73岁,平均59.5岁;病程1～4个月,平均2.5个月。原发病灶:肺癌8例,乳腺癌4例,前列腺癌4例,肝癌2例,甲状腺癌1例,原发病灶不明2例。脊髓神经功能按Frankel分级:B级4例,C级6例,D级5例,E级6例。通过比较手术前后腰背部疼痛VAS评分、病椎前后缘高度、Cobb角及脊髓神经功能恢复程度来分析临床结果。结果:21例患者手术顺利,无严重并发症发生,无脊髓、神经功能加重。术后1周VAS评分由术前的(8.78±0.45)分减少至(2.25±0.36)分。16例合并病理性骨折者,病椎前缘高度由术前(12.7±2.1)mm增加到术后的(19.5±3.9)mm,病椎后缘高度由术前(14.1±1.8)mm增加到术后的(20.3±2.3)mm,Cobb角由术前(26.0±8.9)°减少到术后的(6.0±0.9)°。各项指标与术前相比,差异均有统计学意义(P0.05)。术后脊髓神经功能按Frankel分级:C级2例,D级4例,E级15例。21例均获得随访,时间5～28个月,平均14个月,未发生内固定松动及断裂。15例随访期间死亡。结论:在椎管后路减压内固定的同时,行开放性椎体成形术,手术创伤小、安全性高,能有效重建脊柱稳定性,减轻疼痛,提高患者的生活质量,对于身体状况较差、预期寿命较短的脊柱转移性肿瘤患者提供了一种可选择的手术方式。

Clinical study of open vertebroplasty in treating thoracolumbar metastatic tumor

Objective: To explore the clinical application and therapeutic effect of open vertebroplasty for thoracolumbar metastatic tumor. Methods: From September 2003 to December 2009,21 patients with thoracolumbar metastatic tumor underwent the surgical procedure of posterior spinal cord decompression and open vertebroplasty combined with short-segmental pedicle screw fixation during the same intervention. There were 14 males and 7 females,ranging in age from 48 to 73 years with the mean of 59.5 years and ranging in course of disease from 1 to 4 months with an average of 2.5 months. The primary focus of the tumor of 19 cases were established,lung carcinoma was in 8 cases,breast cancer in 4 cases,prostate carcinoma in 4 cases,hepatocarcinoma in 2 cases and thyroid carcinoma in 1 case. The primary focus of 2 cases could not be established. The spinal function according to Frankel grade,grade B was in 4 cases,C in 6,D in 5,E in 6. The lumbar-back pain,height of anterior and posterior vertebral body,Cobb angle and spinal function were recorded before and after operation. Results: The operation of all patients was successful,there were no severe complications and aggravation of spinal function. The VAS score of lumbar-back pain decreased from 8.78±0.45 preoperatively to 2.25±0.36 postoperatively. Among 16 cases combined with pathological fracture,the height of anterior spinal vertebral body increased from(12.7±2.1) mm preoperatively to(19.5±3.9) mm postoperatively;the height of posterior spinal vertebral body increased from(14.1±1.8) mm preoperatively to(20.3±2.3) mm postoperatively;Cobb angle decreased from (26.0±8.9)° preoperatively to(6.0±0.9)° postoperatively. There was significant difference above items between before and after operation(P<0.05). The spinal function according to Frankel grade at final follow up,grade C was in 2 cases,D in 4,E in 15. All patients were followed up from 5 to 28 months with an average of 14 months,there was no loosening and breakage of internal fixity,15 cases died during follow-up period. Conclusion: The surgical intervention can effectively preserve spinal instability and alleviate the spinal cord symptoms,improve the life quality of patients. It may provide an alternative treatment for patients in poor general health and shorter life expectancy.