胸腰椎转移瘤的外科治疗策略和效果分析

Surgical strategy for the treatment of thoracolumbar metastatic tumor and its clinical outcomes

目的：探讨胸腰椎转移瘤的外科治疗策略和效果。方法：回顾性分析2009年1月到2010年12月收治的行外科手术干预治疗并获得随访的胸腰椎转移瘤患者共42例。男30例，女12例；平均年龄56.8岁（28～76岁）;胸椎转移瘤25例，腰椎转移瘤17例；单节段34例，双节段6例，3节段2 例。2例无症状，40例有腰背部或下肢疼痛。18例脊髓功能受损，其中ASIA分级 A级5例，B级3例，C级4例，D级6例。Tomita评分2～7分，术前根据Tomita评分制定手术目标，根据Tomita外科分期制定具体手术方案，分别行全椎体切除，肿瘤彻底刮除及姑息性椎管减压稳定手术。术后1周、3个月、6个月、1年及2年对患者疼痛、脊髓功能、肿瘤局部控制、生存、内置物情况进行评估。结果：42例术中死亡1例。术后1周38例疼痛缓解，5例完全性瘫痪中2例神经功能恢复至E级，2例恢复至D级，1例未恢复，13例不全瘫痪者均有1级以上恢复。随访24～48个月，内固定物失效1例，5例局部肿瘤复发或失去控制。术后3个月、6个月、1年及2年存活率分别为95.2%、85.7%、58.2%和37.6%.结论：对于脊柱转移瘤患者，通过Tomita评分和外科分型选择合适手术方式，可缓解疼痛，改善神经功能，增加脊柱稳定性，控制局部病灶，提高患者生存质量。

Objective： To evaluate surgical strategy and clinical outcomes for the treatment of thoracolumbar metastatic tumor. Methods： From January 2009 to December 2010,42 patients with thoracolumbar metastatic tumor were treated surgically. Among the patients,30 patients were male,and 12 patients were female,ranging in age from 28 to 76 years old,with an average age of 56.8 years old. Twenty-five patients had metastatic tumor in thoracic vertebraes,and 17 patients had metastatic tumor in lumbar vertebraes. Thirty-four patients had metastatic tumor in 1 segment,6 patients had metastatic tumor in 2 segments and 2 patients had metastatic tumor in 3 segments. Two patients had no symptoms and 40 patients had back or leg pain. Eighteen patients had neurologic deficits,and 5 patients had injuries of A degree,3 patients had injuries of B degree,4 patients had injuries of C degree,6 patients had injuries of D degree according to ASIA grading system. The operation goal was made according to Tomita evaluation. The surgical procedures included pallative decompression,tumor curettage and total vertebrectomy,which were decided based on Tomita classification. The pain,spinal cord function,part control of tumor,survival rate and conditions of internal fixation were evaluated at 1 week,3 months,6 months,1 year and 2 years after operation. Results： One patient died in the operation. Pain relief was obtained in 38 patients after operation. Among 18 patients suffering from spinal cord compromise,17 patients improved 1 to 4 grades after surgery according to the ASIA grading system. All the patients were followed up and the duration ranged from 24 to 48 months,with a mean time of 34.2 months. Five patients got recurrence. The postoperative survival rates at 3 months,6 months,1 year and 2 years were 95.2%,85.7%,58.2%,37.6% respectively. Conclusion： According to Tomita system,the different surgical treatments can be selected for patients with spinal metastatic tumors,which can relieve pain,improve the neurological status and spine stabilization,maintain local control,improve quality of life.