胸腰椎转移瘤后路手术中骨水泥的应用

目的:探讨骨水泥在胸腰椎转移瘤后路手术中的应用价值.方法:2004年3月～21208年12月,后方入路手术治疗胸腰椎转移性肿瘤患者26例,原发肿瘤:肺癌9例,乳腺癌7例,肝癌4例,前列腺癌2例,肾癌1例,来源不明3例.病灶累及单节段17例,两节段9例.23例伴不同程度的腰背部疼痛:神经功能按Frankel分级:B级6例,C级7例,D级11例,E级2例.术中采用骨水泥联合椎弓根螺钉重建脊柱稳定性,其中骨水泥填塞15个椎体,骨水泥前方重建9个椎体,骨水泥椎体成形11个椎体,10例合并骨质疏松患者同时采用骨水泥加强椎弓根钉道.结果:术中未发现骨水泥放热效应引起的神经功能受损.24例患者获得完整随访,随访时间3～42个月,平均18.2个月,23例术前有不同程度腰背疼痛者术后疼痛消失6例,缓解14例;术前伴神经功能障碍者17例(77%)获得神经功能改善.随访期间未发现骨水泥下沉、椎节塌陷及向前成角.1例骨水泥填塞术后3个月骨水泥界面出现松动,但未引起神经压迫症状.15例随访期间死亡.结论:在胸腰椎转移性肿瘤后路手术治疗中,根据患者的全身情况、预期寿命、肿瘤类型、转移椎体位置及骨密度,充分利用骨水泥独特的理化特性,进行多种不同方式的应用,可以减小手术创伤,提高生存质量.

Application of bone cement in the posterior approach surgical treatment for metastatic tumor of the thoracolumbar spine

Objective:To explore the clinic effects of the bone cement utilized in the posterior approach surgical treatment of the thoracic and lumbar spinal metastatic tumor.Method:26 patients with the thoracolumbar spinal metastatic tumors who underwent posterior approach surgical treatment from March 2004 to December 2008 were reviewed retrospectively.There were lung carcinoma in 9 cases, breast carcinoma in 7 cases, hepato-carcinoma in 4 cases,prostate carcinoma in 2 cages,kidney carcinoma in 1 case,and 3 cases with unknown origin.Tumor involved single vertebral body in 17 cases,two vertebral bodies in 9 cases.23 patients complained of various back pain,neurofunction classification based on Frankel grading system presented B in 6,C in 7,D in 11 and E in 2.The multilevel posterior pedicle screw instrumentation combined with bone cement were performed on all patients to reconstruct the spine stability. 15 vertebral bodies were packed by bone cement,9 vertebral bodies were reconstructed with bone cement after total spondylectomy, 11 vertebral bodies were treated by vertebroplasty.10 patients with osteoporosis underwent augmentation of pedicle screw path by bone cement at the same time.Result:There was no neurofunction injury duo to heating effect from bone cement during the operation,24 patients were followed up 3 to 42 months with a mean of 18.2 months After the operation,the pain was relieved in 20 cases,the nerve compression symptoms were improved in 17 cases. The internal fixation was firmly seated with no bone coment sinked.no vertebra body corruption and no pedicel break.15 cases died during the follow-up.Conclusion: During the posterior approach surgical treatment of thoracolumbar spinal metastatic tumor,based on the patient general condition,life expectancy,neurological deterioration, tumor type and location within spine,and quality of the vertebra,proper use of bone cement can minimize surgical injury and increase living quality of the patients as bone cement has unique physicochemi-cal characteristics.