颈胸腰椎骨髓瘤的外科治疗

目的：探讨脊柱骨髓瘤的手术治疗及指征。方法：回顾性分析19例脊信骨髓瘤患者的手术治疗结果,其中男13例,女6例,年龄31-52岁,平均45.1岁。所有患者术前均主诉严重的腰背痛,其中合并脊髓功能损害9例,根据Frankel分级,FrankelB5例,Frankel C3例,Frankel D1例。术前明确诊断14例,术后病理证实诊断5例。单纯后路内固定7例（其中使用CD3例,使用Luque2例,使用Luque环1例,使用TSRH1例）,其中2例系因外院后路减压后效果不佳而转入我院,再次行后路减压CD内固定。椎体次全切除植骨、zplate钢板固定1例,人工椎体置换5例,前路钢板骨水泥固定5例,前路肿瘤切除钢板骨水泥内固定、后路Luque内固定融合1例。结果：除1例随访为6月,余患者均随访1年以上,1年后失访4例。1例随诊8年仍存活,余患者存活16-48个月,平均存活为26.5个月。住院期间除1例术后出现肠道菌群失调外,术后均无手术相关并发症的发生。根据主观症状及对止痛药的依赖,术后患者的疼痛均得到明显的缓解,截瘫症状亦得到明显改善;术后FrankelC1例,FrankelD4例。结论：手术可使患者症状快速而持久地得到缓解,但应结合应用其他的辅助治疗,如放疗、化疗或免疫治疗,方能巩固治疗的效果。

Surgical treatment of spinal myeloma,report of 19 cases

OBJECTIVES: To discuss the indications for surgical procedures of spinal myeloma. METHODS: A retrospective analysis was made of the data of operation results of Nineteen patients with spinal myeloma, 13 males and 6 females, with the mean age of 45.1 (range 31 approximately 52). Pain was present in all patients. Nine patients had neurological deficit. According to Frankel classification 5 cases were Frankel B, 3 cases were Frenkel C, and 1 case was Frenkel D. Fourteen cases were diagnosed before operation, and 5 cases were diagnosed by pathology after operation. Surgical procedures performed included anterior approach in 11 cases, posterior approach in 7 cases and combined approach in 1 case. RESULTS: Decrease of pain was observed in all cases after surgery. Neurological improvement was observed in 8 out of the 9 cases. Complication (alteration of intestinal flora) occurred in one case. Follow-up lasted more than 1 year except in one case with a follow-up of only 6 months. Four cases were lost of follow-up. One case was still alive during the follow-up 8 years after operation. Other cases survived for 26.5 months on average (range 16 approximately 48 months). CONCLUSION: Surgery can ensure neurological improvement and spinal stability for patients with spinal myeloma, but should be associated with adjunctive medical treatment.