肺癌转移瘤脊髓压迫症术后行走功能转归及其相关因素

目的探讨肺癌脊柱转移瘤脊髓压迫症(MSCC)术后运动功能转归及其相关影响因素。方法回顾性分析2010年1月—2015年5月于本院接受后路椎板切除椎管减压钉棒系统内固定术治疗的56例肺癌MSCC患者的临床资料。疼痛评估采用视觉模拟量表(VAS)评分,脊髓功能评估采用Frankel分级,体力状态评估采用卡氏功能状态(KPS)量表。采用Logistic回归法分析肺癌组织学类型、术前行走状态(Frankel分级)、责任椎体有无病理性骨折、脊柱转移灶数目、发生运动功能损伤与手术间隔期、压迫节段、手术方式与术后行走状态的相关性。结果 VAS评分由术前(6.4±1.2)分降至术后1周(2.3±1.1)分,差异有统计学意义(P0.05)。KPS评分由术前平均62分上升至术后70分,差异有统计学意义(P0.05)。56例患者术前可行走率(Frankel分级D级及以上)为46%(26/56),术后可行走率为75%(42/56)。术后4周31例患者Frankel分级提高,22例Frankel分级维持不变,3例Frankel分级下降。术后Frankel分级较术前明显提高,差异有统计学意义(P0.05)。回归分析示术后行走状态与术前行走状态和发生运动功能损伤与手术间隔期存在相关性。结论术前行走状态好、发生运动功能损伤与手术间隔期短的肺癌MSCC患者术后行走状态好,有症状的肺癌MSCC患者应当在减少并发症的前提下尽早接受手术治疗。

Postoperative outcome of ambulation function and prognostic factor analysis for metastatic spinal cord compression from lung cancer

Objective To explore postoperative outcome of ambulation function and prognosis-associated factors for metastatic spinal cord compression(MSCC) from lung cancer. Methods The clinical data of 56 patients who were operated for MSCC from January 2010 to May 2015 were retrospectively analyzed. The visual analogue scale(VAS) score and Frankel classification were used to evaluate the pain intensity and dysfunction of spinal cord, respectively. The physical status was assessed by the Karnofsky performance status(KPS) scale. Logistic regression analysis was applied to explore the possible correlation between histology, preoperative motor status(Frankel classification), pathologic fractures of responsible vertebral body, number of spinal metastases, the time interval of motor status impairment and surgery, location of spinal compression, surgical procedure and postoperative motor status. Results The VAS score decreased from preoperative 6.4±1.2 to postoperative 2.3±1.1, and the difference was statistically significant(P<0.05). The KPS score increased from preoperative 62 to postoperative 70, and the difference was statistically significant(P<0.05). The pre-and postoperative ratio of patients who were able to walk was 46%(26/56) and 75%(42/56), respectively. The grade of Frankel classification was increased in 31 cases, unchanged in 22 cases and decreased in 3. The postoperative Frankel classification was significantly higher than that before operation, and the difference was statistically significant(P<0.05). Logistic regression analysis showed that there was a correlation between the preoperative motor status and postoperative motor status and between the motor function impairment and surgical interval. Conclusion Better preoperative motor status and shorter interval between motor function impairment and surgery would have a better postoperative motor status in the patients with MSCC from lung cancer. On the premise of reducing complications, symptomatic MSCC patients are recommended to surgery as soon as possible.