脊柱转移瘤的前路手术治疗

Surgical Treatment of Metastatic Spinal Tumors by Anterial Approach

目的研究脊柱转移瘤引起的椎体塌陷、脊髓压迫或顽固性疼痛的患者经前路手术治疗的效果。方法1997年12月～2003年12月,我中心经前路手术治疗脊柱转移瘤患者93例,包括胸椎转移53例,腰椎转移33例,颈椎转移7例。男性53例,女性40例。原发肿瘤为:肺癌21例、肾癌13例、前列腺癌8例、肝癌5例、乳腺癌13例、甲状腺癌5例、结肠癌3例、多发性骨髓瘤8例、未发现原发病灶者17例。无明显神经系统受累者39例;出现神经系统受损者54例,其中完全瘫痪者16例,不完全瘫痪者38例。病变累及1个脊椎节段者69例,2个脊椎节段者20例,3个以上脊椎节段者4例。所有接受手术患者的预期生存时间均超过6个月。随访时间为10～72个月。结果93例患者中,87例(93.5%)术后疼痛得到缓解;54例有神经功能损害的患者中,47例术后麻痹症状改善;16例完全瘫痪的患者中,7例在减压术后Frankel分级提高了1～2个等级;未见严重并发症;术后存活1年以上的患者79例,约占患者总数的85%。结论对于单节段或两个相邻节段的脊椎转移瘤应按原发肿瘤处理,行前路手术彻底切除肿瘤,坚强的内固定术。对于脊椎转移瘤压迫脊髓的病例均应尽早行肿瘤切除椎管减压手术,缓解神经麻痹症状,增加脊椎稳定性,提高生存质量。

Objective To investigate the efficacy of surgical treatment of the patients with metastatic spinal tumors by anterial decompression and stabilization. Methods From December 1997 to December 2003, 93 patients(40 women and 53 men)with metastatic spinal tumors were treated in our department. The locations of the tumor included, thoracic vertebra(53 cases), lumbar vertebra(33 cases), and cervical region(7 cases). The original tumors included lung cancer(21 cases), renal cancer(13 cases), prostate cancer(8 cases), hepatic cancer(5 cases), breast cancer(13 cases), thyroid cancer(5 cases), gastrointestinal tumor(3 cases), and multiple myeloma(8 cases). However, no primary tumor was found in the rest of 17 cases. Among 54 of 93 patients who presented with neurological dysfunction, 16 patients completely paralyzed and others incompletely paralyzed. The follow-up time ranged from 10 to 72 months. Results Pain was relieved in 87 of 93 patients(93.5%)and neurological function was improved in 47 of the 54 patients. Among 16 completely paralyzed patients, 7 patients experienced a neurological function improvement(from Frankel grade A or B to C or D after decompression). The average amount of blood transfused was 3 000 ml. No severe complications were seen in our series. The one-year survival rate was 85%(79 cases). Conclusions The integrity of the spinal column structure and neurological function should be considered firstly in the treatment of spinal metastasis. Thorough resection of metastatic tumor and stable internal fixation by anterior approach should be performed when single or two vertebra are involved. In order to alleviate paralysis, promote spinal stability, and improve the quality of life, urgent decompression should be performed on patient with spinal metastasis.