微创手术治疗脊柱转移瘤的临床研究

  目的  探索经皮椎弓根螺钉联合微创治疗手段在脊柱转移瘤中的疗效。  方法  回顾性分析2019年10月至2021年9月天津医科大学肿瘤医院收治的脊柱转移瘤患者15例。患者均行经皮椎弓根螺钉联合微创治疗，术后给予综合治疗，治疗前和治疗后3个月对患者疼痛、神经损伤、功能状态等进行评估。  结果  患者随访3～23个月，平均生存时间为13.5个月，中位生存时间14.0个月。平均手术时间为（232.3±17.9）min，术中出血量为（393.3±64.9）mL，椎体骨水泥平均注射量3.38 mL。治疗前VAS评分（7.67±0.25）分，术后3个月VAS评分（2.73±0.15）分，治疗后疼痛明显缓解（P<0.01）；14例患者Frankel分级提高1个等级，1例患者术前为Frankel D级，经过微创手术治疗后分级无变化；术前、术后3个月KPS评分得到明显改善（P<0.01）。  结论  经皮椎弓根螺钉联合小切口椎板减压手术能够有效缓解脊髓压迫症状，减轻疼痛，提高患者生存质量。 

Clinical study of minimally invasive surgery for spinal metastases

  Objective  To assess the efficacy of percutaneous pedicle screw fixation combined with minimally invasive surgery for spinal metastases.   Methods  From October 2019 to September 2021, fifteen patients with spinal metastases from Tianjin Medical University Cancer Institute & Hospital were retrospectively analyzed. The patients underwent percutaneous pedicle screw internal fixation combined with minimally invasive surgery. The patients also received comprehensive treatments after surgery. They were followed up after treatment, and pain, nerve injury, and functional status were evaluated before and three months after surgery.   Results  The patients were followed up for 3-23 months. The average and median survival times of the patients were 13.5 and 14.0 months, respectively. The average operation duration was (232.3±17.9) min, amount of intraoperative bleeding was (393.3±64.9) mL, and average amount of vertebral bone cement injection was 3.38 mL. The visual analogue scale(VAS) scores were 7.67±0.25 and 2.73±0.15 before and three months after surgery, respectively. Pain was significantly relieved after surgery (P<0.01); the Frankel grade increased by one grade in 14 patients. One patient had Frankel grade D before surgery, and there was no change in the grade after surgery. The Karnofsky performance scale score significantly improved before and 3 months after surgery (P<0.01).   Conclusions  Percutaneous pedicle screw fixation combined with short incision can effectively alleviate symptoms of spinal cord compression, reduce pain, and improve patients’ quality of life.