椎弓根内固定结合椎体成形术治疗胸腰椎体转移瘤临床研究

Clinical application of pedicle fixation combined with vertebroplasty surgery in treatment of thoracolumbar body metastatic tumers

[目的]观察椎弓根内固定术结合直视下椎体成形术治疗胸腰椎体转移性肿瘤的临床疗效。[方法]对30例胸腰椎转移性肿瘤的患者采用后路椎弓根内固定术结合直视下骨水泥椎体成形术,共治疗32个椎体,患者均有顽固性腰痛及下肢神经症状,部分患者行椎管减压。随访观察临床疗效。[结果]本组32个椎体全部穿刺成功,骨水泥渗漏3例,均未出现神经症状,患者术后1周,3、6、12个月各时间点VAS评分疼痛缓解率>80%,活动能力和生活质量评分明显改善,随访12个月期间生存患者有24例,胸腰椎疼痛未见明显加重,病椎高度未见明显压缩,1例肺癌患者术后10个月出现肿瘤复发,其余患者手术椎体未出现新的病理性骨折及神经症状加重。[结论]椎弓根内固定结合椎体成形术治疗胸腰椎转移性恶性肿瘤能明显改善患者生存质量,预防病理性骨折进一步塌陷,疗效满意,是综合治疗胸腰椎肿瘤的重要治疗方法之一。

[Objective]To study the clinical efficacy of pedicle fixation combined with a direct vertebroplasty in the treatment of metastatic tumors in the lumbar and thoracie spine.[Methods]Thirty-two vertebral bodies of thirty thoracolumbar metastatic tumor patients underwent pedicle fixation combined with a direct vertebroplasty.All patients had intractable back pain and lower limbs neurologic symptoms.Some patients suffered from vertebra canal decompression,and all the patients were followed up.[Results]Successful acupuncture were achieved in all thirty-two vertebrae.Bone cement leakage occured in 3 cases.No neurological symptoms occurred.VAS score and effective pain relief rate were above 80% at the time points of 1 week,3-,6-and 12-month after operations.Scores of mobility and quality of life improved significantly.Twenty-four patients surived during the 12-month follow up period.The back pain didn＇t increse.The height of the vertebral body did not shorten.One case with lung cancer at ten month appeared tumor recurrence,the other patients＇ diseased vertebraes did not appear new pathologic fracture and neurologic symptoms worsing.[Conclusion]The pedicle fixation combined with vertebroplasty surgery for the treatment of metastatic tumors in the lumbar and thoracic spine improved quality of life with satisfactory efficacy,and prevented diseased vertebrae from further fracture and compression.It is a comprehensive treatment of thoracolumbar metastatic vertebrae tumors.