脊柱转移瘤硬膜外脊髓压迫症后路减压内固定术疗效观察

Curative effect analysis of posterior decompression and internal fixation for spinal metastases epidural spinal cord compression

目的观察后路椎板切除椎管减压钉棒系统内固定术治疗脊柱转移瘤硬膜外脊髓压迫症（MESCC）的疗效。方法回顾性分析2006年1月至2014年12月于解放军第三。七医院骨科接受胸椎后路椎板切除椎管减压钉棒系统内固定术的67例转移瘤硬膜外脊髓压迫症的患者临床资料。收集患者年龄、性别、原发肿瘤类型、术前卡氏（KPS）评分、手术前后疼痛视觉评分、手术前后Frankel分级、影像学特征（受累椎体数、分布、压缩骨折）、出现运动功能障碍和手术的间隔期、生存期等数据。结果随访（13．3±14．3）（1．2～88．9）个月。截至随访结束，病死57例，存活10例，中位生存期8．1（1．2～91．9）个月。38例（67％）术后1年内病死，50例（88％）术后2年内病死。疼痛视觉评分（VAS）由术前（5．7±1．7）分下降至术后（2．1±1．4）分，P〈0．001；38例（53％）患者Frankel分级至少改善1个等级。34例术前无法行走的患者中15例术后获得行走能力。KPS评分≥80分、术前具有行走能力的患者术后运动功能状态较好。结论后路椎板切除椎管减压钉棒系统内固定术是治疗MESCC的有效方法，可以有效缓解疼痛，减轻脊髓压迫，改善神经功能状况，改善患者生活质量。术前步行能力、运动功能障碍发生时间、术前KPS评分与术后运动功能状态相关。

Objective To explore the effects of posterior decompression and internal fixation for spinal metastases epidural spinal cord compression （MESCC） and analyze the related factors of postoperative ambulation function. Methods Clinical data of 67 cases with MESCC who received thoracic posterior decompression and internal fixation in our department from January 2006 to December 2014 was retrospectively analyzed. Information about patients＇ age, gender, pathological type of primary tumor, Karnofsky performance status （KPS） score, pre-operative and postoperative visual analogue scale, preoperative Frankel grade, pre-operative and postoperative imaging characteristics （number of thoracic vertebrae metastases, location, compression fractures of vertebral bodies） , time of movement dysfunction and survival was collected. Results At the end of the follow-up of 67 cases, 57 cases were dead, 10 cases were alive, and the median survival was 8. 1 months （ 1.2 -91.9 months）. 38 cases （67%） died within one year, 50 cases （88%） died within two years. Visual analogue scale of preoperative and postoperative dropped from （5.67 ± 1.67） points to （ 2. 11 ± 1.39 ） points （ P 〈 0. 001 ）, 38 （ 53% ） patients＇ Frankel grade improved at least one grade. Among the 34 cases who were unable to walk, 15 cases regained ability of ambulation after surgery. The patients with KPS scores greater than 80 points and/or had preoperative ambulation ability, tended to have better postoperative ambulatory function. Conclusions Posterior decompression and internal fixation for MESCC is effective, and can effectively relieve pain and spinal cord compression, improve neurological function and the quality of life. The ambulatory functional outcomes after surgery are dependent on KPS scores, the occurrence time of neurological dysfunction, preoperative ambulatory status.