开放性椎体成形术治疗胸腰椎转移瘤的临床观察

Clinical observation of open vertebroplasty in the treatment of thoracolumbar metastasis

目的探讨开放性后路椎体成形术在胸腰椎转移瘤治疗中的应用价值。方法 2013年1月至2015年3月我科收治的45例胸腰椎转移性肿瘤患者,行后路椎管减压后柱转移瘤切除短节段椎弓根螺钉内固定联合直视下骨水泥椎体重建术。评估手术前后腰背部疼痛VAS评分和神经功能损害程度(Frankel分级)。结果 45例患者均安全度过围手术期。33例术前有不同程度腰背疼痛者,术后疼痛消失11例,缓解22例。26例术前伴神经功能障碍者(79%)获得神经功能改善。术中未出现骨水泥引起的神经功能损伤。患者在治疗前和术后1个月VAS评分分别为(8.02±0.51)分和(2.7±0.34)分,差异有统计学意义(P<0.01)。44例获随访,1例术后失访;随访7~32个月,平均16个月。35例死亡,其中术后6个月内死亡3例,7~12个月死亡18例,1~2年死亡11例,2年以上死亡3例;现存活的9例患者中6~12个月5例,1~2年4例。随访期间复查未发现骨水泥下沉、松动、椎节塌陷及向前成角。结论后路椎管减压后柱转移瘤切除短节段椎弓根螺钉内固定联合直视下骨水泥椎体重建术,简单安全,既能有效减压缓解疼痛,又可维持脊柱稳定,为提高脊柱转移性肿瘤患者的生存提供了一种有效治疗方法。

Objective To investigate the clinical application and efficacy of open posterior vertebroplasty in treatment of tho- racolumbar metastatic tumor. Methods From January 2013 to March 2015, forty-five patients with thoracolumbar metastatic tumor were treated by the operation of posterior spinal canal decompression tumor resection within the fixation of a short segment pedicle screw and bone cement vertebral reconstruction under direct vision. The lumbar-back pain （ VAS score） and neurological damage （ Frankel classification） were assessed and compared before treatment and 1 month after treatment. Results Forty-five patients were safe periop- erative period. Thirty-three patients have varying degrees of low back pain disappeared in I 1 cases, 22 cases of remission. Twenty-six cases with preoperative neurological disorders （79%） obtain improved neurological function. There was no intraoperative neurological damage caused by bone cement. The preoperative and postoperative 1 month VAS score were 8.02±0. 51, 2. 7±0. 34, and the differ- ences were statistically significant （P〈O. 01 ）. Forty-four cases were followed up and 1 patient lost to follow. The durations of followed up ranged from 7 to 32 months, an average of 16 months. There were 35 cases died, including 3 cases within 6 months, 18 deaths in 7 to 12 months, 11 cases in 1 to 2 years, 3 cases in more than 2 years. Nine patients survived, 5 cases in 6 to 12 months, and 4 cases in 1 to 2 years. During follow-up, no bone cement sink, loose vertebrae collapse and angled forward was found. Conclusion The opera- tion of posterior spinal canal decompression tumor resection within the fixation of a short segment pedicle screw and bone cement verte- bral reconstruction under direct vision are simple and safe. It not only effectively relieve and reduce pain, but also maintain the stability of the spine, and provide a effective therapeutic method for improving the survival of patients with spinal metastatic tumor.