脊柱转移肿瘤的外科治疗方法探究

背景：脊柱是恶性肿瘤中除肺脏、肝脏外最常见的转移部位。脊柱转移肿瘤严重影响患者的生活质量，近年来患者的生存期延长，多数骨科医师选择手术治疗改善患者的生存质量。目的：初步评估脊柱转移肿瘤切除和脊柱重建的疗效。方法：2001年1月至2009年11月收治脊柱转移肿瘤患者42例，分别进行前路椎体切除，后路椎板切除减压，一期后路全椎体切除术和经皮椎体成形术。对比各种手术的手术时间、平均出血量、术后疼痛缓解率和症状缓解率。结果：随访时间为5-108个月。前路椎体切除手术平均手术时间234min，出血量1966ml，术后疼痛缓解率为83％，症状缓解率为33％；后路椎板切除减压手术平均手术时间218min，出血量1292ml，术后疼痛缓解率为85％，症状缓解率为28％；一期后路全椎体切除术手术平均手术时间290min，平均出血量2275ml，术后疼痛缓解率为100％，症状缓解率为57％；经皮椎体成形术时间短、出血量少（均未统计），疼痛缓解率为100％，之前均无症状。结论：一期后路全椎体切除术手术时间较长，平均出血量较多，但术后症状缓解率和疼痛缓解率较高，对于单节段病变椎体或者致病椎为单节段、无重要内脏转移、一般情况较好、预期寿命超过半年的患者，应采用一期后路全椎体切除术以达到解除病痛的效果。

The study on the surgical treatments of spinal metastatic tumor

Background:Spine is the most common site of metastases of malignant tumors except lung and liver,and life quality of patients was affected severely.With the lengthening of lifetime in recent years,a lot of orthopaedists select surgical treatment to improve the qulity of life of patients.Objective:The purpose of the present study is to evaluate the clinical outcomes of resection of spinal metastatic tumor and spinal reconstruction.Methods:From January 2001 to November 2009,42 patients with spinal metastatic tumor were treated by different operations including anterior resection of vertebral body,posterior decompression,anterior vertebral lesion resection,percutaneous vertebroplasty(PVP) and one stage posterior vertebral column resection and reconstruction.Operative time,blood loss,pain relief rate and symptom relief rate of different surgical treatments were compared.Results:The follow-up ranged from 5 to 108 months.The average operative time,bleeding,postoperative pain relief rate and symptom relief rate of anterior resection of vertebral body were 234 min,1966 ml,83% and 33%,respectively.They were 218 min,1292 ml,85% and 28%,respectively in posterior decompression;and were 290 min,2275 ml,100% and 57%,respectively in one-stage posterior vertebral resection and reconstruction.Surgical time of PVP was short and bleeding was less(not calculated),pain relief rate was 100% and the patients had no symptoms before treatment.Conclusions:Although the surgical time of posterior one-stage vertebral resection and reconstruction is longer and the average bleeding is more,pain relief rate and symptom relief rate is higher.It is advised to use this method to treat the patients with one segment affected(or the key lesion is localized in one segment),no visceral metastases,good general condition and the expected survival period more than 6 months.