肿瘤切除同时后路内固定手术治疗胸腰椎肿瘤

Treatment of Spinal Thoracolumbar Tumor by Posterior Pedicle Internal Fixation at One-stage

目的探讨肿瘤切除同时后路内固定手术治疗胸腰椎肿瘤的疗效。方法 2007年6月至2009年12月收治的胸腰段肿瘤患者42例,其中男性28例,女性14例;年龄24～69岁,平均48.5岁。原发性肿瘤16例,转移瘤26例,所有患者行肿瘤切除同时后路内固定术。随访6个月～3年,平均19.5个月。主要观察记录：手术时间、术中失血、术后并发症、疼痛缓解、神经功能恢复、生存时间、生活质量、植骨融合及Cobb′s角纠正情况等。结果手术时间（150±20）min,术中失血量（1 200±125）mL,所有病例疼痛消失或减轻。视觉模拟疼痛评分术前平均8.3分,术后6个月平均1.0分,术前术后有显著性差异（P〈0.01）;术前Frankel分级：A级0例,B级2例,C级8例,D级18例,E级14例,术后半年C级4例,D级6例,E级32例,与术前比较差异有统计学意义（P〈0.01）;生活质量评估术前、术后6个月分别为（35.4±7.3）分,（62.5±10.5）分,有显著性差异（P〈0.01）。术后半年复查X线片脊柱结构稳定,全部病例植骨呈骨性融合,矢状面Cobb′s角均无丢失。所有病例切口均一期愈合,无严重并发症发生。原发肿瘤中2例骨巨细胞瘤术后6个月肿瘤局部复发,再次手术,术后5个月死亡。3例骨肉瘤和2例Ewings瘤患者分别于术后12个月和14个月死于肺转移。转移性肿瘤中4例前列腺癌、6例肺癌患者分别于术后8～12个月由于多器官转移死亡,3例乳腺癌患者术后9个月死于肝功能衰竭,2例肾癌转移患者局部肿瘤复发放弃治疗后全身恶病质死亡。其余的患者至末次随访仍存活,生活质量可。结论在严格把握手术适应证及手术时间等条件下,肿瘤切除同时后路内固定手术治疗胸腰椎肿瘤可获得较好的治疗效果。

Objective To explore the efficacy of surgical treatment of spinal thoracolumbar tumor by posterior pedicle internal fixation at onestage.Methods Forty-two cases of thoracolumbar spinal tumor were retrospectively studied from June 2007 to December 2009.including 28 males and 14 females,aged from 24 to 69 years old.Of them,there were 16 cases of primary tumor and 26 cases of metastatic tumor.All patients received the treatment of spinal thoracolumbar tumor by posterior pedicle internal fixation at one-stage.All cases were followed-up for 6 months to 3 years,the average of 19.5 months.The operation time、blood loss、the complications of surgery、easement of pain、recovery of neurological function、life time、quality of life、the rate of bone-healing rate and the correction of kyphosis were documented postoperatively.Results The average operation time was（150±20） min,the average blood loss was（1 200±125） mL.All the cases′s pain was disappeared or easement.The VAS scorces were decreased from 8.3 preoperation to 1 six months postoperation,which showed significant difference（P〈0.01）.The quality of life scorces were increased from（35.4±7.3） preoperation to（62.5±10.51）six months postoperation,which showed significant difference（P〈0.01）.The grade of neurological function recorded by frankel preoperation was：grade A 0,grade B 2,grade C 8,grade D 18,grade E 14 and that was 0,0,4,6,32,six months postoperation,which showed significant difference（P〈0.01）.The X-ray showed that spinal structural stability,bone graft was finance and no loss of cobb angle.The wound primary healing achieved in all patients,no severe complications were came up.Two giant cell tumor of bone recurred and received debridement surgery,but died after 5 months.Three osteosarcomas and two ewings tumers were died from pulmonary metastasis 12 and 14 months postoperation.In metastatic tumors,four prostatic cancers and six lung cancers died from organs metastatic from 8 months to 12 months after operation.Three breast cancer died of hepatic failure 9 months after operation.two renal carcinomas were died of cachexia.Other patients were well by the time of last follow-up.Conclusion Under the conditions of surgical indications and the operation time strictly,the treatment of spinal thoracolumbar tumor by posterior pedicle internal fixation at one-stage can receive better treatment effection.