手术切除联合椎体成形术治疗多发性脊柱肿瘤的疗效观察

目的 探讨外科手术切除病灶联合椎体成形术治疗多发性脊柱肿瘤的疗效.方法 对多发性脊柱肿瘤患者18例,采用经前路切除肿瘤、经后路椎管减压、姑息性肿瘤切除、经椎弓内固定术等手术方法,同时利用骨水泥做椎体成形术.结果 18例患者中15例(83.3%)术后疼痛得到缓解,麻痹症状改善(9/12,75.0%),平均生存时间8.9个月(3～33个月);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间盘内渗漏各1例.结论 对多发性脊柱肿瘤患者采用外科手术切除联合椎体成形术,可以更好的缓解疼痛,改善神经症状,提高生存质量.

The analysis for multiple spinal neoplasm by two operation methods

Objective To disscuas the effect and complication of spinal operation combined with vertebroplasty in treating formultiple spinal neoplasm. Methods During the last two years, 18 patients with multiple spinal neoplasm including metastases, multiple myeloma andlymphoma were treated by operation combined with vertebroplasty, 2 vertebral body segments were involved in 5 cases, 3 to 4 vertebralbody segments were involved in 9 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 byTomita prognostic scoring system before the operation; The average point was 7.2 (from 3 to 9 points). Results The pain relief ratewas 83.3%(15/18), and neurological recovery was found in 9 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. Conclusion Better results of pain relief and neurological function recovery and living quality can be achieved by surgical palliation of operation combined with vertebroplasty formultiple spinal neoplasm.