脊柱转移瘤姑息性切除减压内固定联合骨水泥填充的临床疗效研究

Clinical efficacy of palliative resection and decompression combined with internal fixation and bone cement filling for spinal metastases

目的探讨姑息性切除减压内固定联合骨水泥填充对脊柱转移瘤的临床疗效。方法对2016年1月至2017年12月在本院行姑息性切除减压内固定联合骨水泥填充术的37例患者行回顾性研究。其中,男21例,女16例;年龄23~71岁,平均(55.0±10.4)岁;受侵犯椎体数为64个,其中胸椎37个,腰椎27个。记录术中出血量、手术时间、单个椎体骨水泥注入量,以及术前、术后视觉模拟评分(visual analogue score,VAS)和Oswestry功能障碍指数(ODI),通过影像学资料评估术前及术后椎体前缘、椎体中部高度变化。结果所有患者手术顺利,随访时间12~18个月,平均(14.7±2.0)个月。随访期间,未出现内固定松动者,1例患者出现手术切口感染,经抗生素治疗及换药后好转,无需外科干预。1例患者于术后16个月因肿瘤转移引起多器官衰竭而死亡。患者术后1周、术后半年及术后1年时的VAS评分及ODI指数和术前相比,差异有统计学意义(P<0.05)。术后1周、术后半年及术后1年时的椎体前缘高度及椎体中部高度与术前相比,差异无统计学意义(P>0.05)。结论脊柱转移瘤姑息性切除减压内固定联合骨水泥填充术能明显缓解患者疼痛,改善功能障碍,维持椎体高度,保护脊柱生物力学稳定性,治疗效果持久,对于改善晚期肿瘤患者的生存质量有积极的意义。

Objective To investigate the clinical efficacy of palliative resection and decompression combined with internal fixation and bone cement filling for spinal metastases.Methods A retrospective study was performed on 37 patients who underwent palliative resection and decompression combined with cement filling in our hospital from January 2016 to December 2017,including 21 males and 16 females.The patients were aged from 23 to 71 years old,with an average age of(55.0±10.4)years old.The number of affected vertebrae was 64,thoracic vertebra 37,and lumbar vertebra 27.The intraoperative blood loss,operation time,single vertebral bone cement injection volume,and preoperative and postoperative visual analog score(VAS)and Oswestry dysfunction index(ODI)were recorded.Preoperative and postoperative imaging datas were used to evaluate the changes of the height of the anterior border and the middle of the vertebral body.Results All patients underwent surgery and were followed up for 12 to 18 months.During the follow-up period,there was no case of internal fixation loosening,and 1 patient developed surgical incision infection,which was improved after antibiotic treatment and dressing change,without surgical intervention.One patient died of multiple organ failure due to tumor metastasis at 16 months after surgery.The VAS score and ODI index of the patients one week after surgery,half year after surgery and one year after surgery were significantly different from those before surgery(P<0.05).There was no significant difference between the height of the anterior border of the vertebral body and the height of the middle part of the vertebral body in one week after operation,half year after operation and one year after operation(P>0.05).Conclusion Spinal metastases with palliative resection and decompression and internal fixation combined with bone cement filling can significantly relieve pain,improve dysfunction,maintain vertebral height,protect the spine biomechanical stability,and have long-lasting therapeutic effect.This has positive meaning to improve the quality of life for patients with advanced cancer.