脊柱转移瘤治疗策略：3D打印技术与精准治疗带来的优势

Treatment strategies for spinal metastases: advantages of 3D printing and precise treatment

背景:脊柱转移瘤患者的预计生存时间相对有限,目前有关脊柱转移瘤的治疗决策尚未形成统一标准。目的:就脊柱转移瘤的诊断、病情评估、治疗策略的最新进展进行综述。方法:使用计算机在PubMed数据库、中国知网和万方数据库检索2010年1月至2018年12月发表关于脊柱转移瘤以及脊柱转移瘤治疗的文献,中文检索关键词为“脊柱转移瘤,病情评估,治疗”,英文检索关键词为“Spinalmetastases,prognosis,therapy”。结果与结论:①共纳入符合标准的文献61篇;②脊柱转移瘤患者的预计生存期有限,且起病较隐匿,肿瘤来源、恶性程度及临床表现多样,准确的病情评估、合理的治疗策略是患者良好预后的关键;③传统的开放性手术创伤大,术中出血较多,术后并发症的发生率较高,脊柱转移瘤的手术治疗已逐渐趋向于微创手术联合术后辅助性治疗;④随着计算机科学以及生物材料学的发展,最新的3D打印技术已应用于脊柱转移瘤的治疗并逐渐成熟,精准切除肿瘤已成为脊柱转移瘤手术的一个新兴趋势;⑤当然原发肿瘤的控制以及全身情况的治疗仍是脊柱转移瘤治疗的基石,多学科、多团队共同参与是达到最佳治疗效果的必备条件。

BACKGROUND: The life expectancy of patients with spinal metastases is relatively limited. Currently, there is no standard for decision-making on the treatment of spinal metastases. OBJECTIVE: To review the latest advances in the diagnosis, assessment and treatment of spinal metastases.METHODS: From January 2010 to December 2018, related literatures on the treatment of spinal metastases and spinal metastases were searched by computer in PubMed, China National Knowledge Infrastructure and WanFang databases. The search keywords of Chinese were “spinal metastases, disease assessment, treatment” and English search keywords “spinal metastases, prognosis, treatment”. RESULTS AND CONCLUSION:(1) A total of 61 eligible literatures were included.(2) Due to the limited life expectancy of patients with spinal metastases and the hidden onset of the disease, the source, malignancy and clinical manifestations of the tumors are diverse;accurate assessment and reasonable treatment strategies are important for good prognosis.(3) Traditional open surgery has a tendency to combine minimally invasive surgery with post-operative adjuvant therapy because of its large trauma, high intraoperative bleeding and high incidence of post-operative complications.(4) With the development of computer science and biomaterials, the latest 3D printing technology has been applied in the treatment of spinal metastases and gradually developed. Accurate resection of spinal metastases has become a new trend of surgery.(5) Of course, the control of primary tumors and the treatment of systemic conditions are still the cornerstone of the treatment of spinal metastases. Multidisciplinary is the necessary to achieve the best therapeutic effect.