分离手术治疗老年脊柱骨转移瘤的临床研究

Clinical effects of separation surgery for metastatic epidural spinal cord compression in patients aged 60 years and older

目的总结分离手术治疗老年脊柱骨转移瘤的临床特征。方法回顾性分析解放军第九六〇医院2014年1月至2018年12月间所有接受分离手术的老年脊柱骨转移瘤患者的临床资料,按性别、年龄、肿瘤类型、累及部位、脊柱稳定性评分(SINS)、硬膜外脊髓压迫分级(ESCC分级)、神经功能评价(Frankel分级)、肿瘤处理方式、内固定方式、手术时间、出血量、术前合并内科疾病、围手术期并发症分别进行统计,分析其临床特征。结果33例老年脊柱骨转移瘤患者纳入本研究,其中男14例(42.4%),女19例(57.6%),男女比例为0.74∶1。发病年龄为60~75岁,平均年龄65.2岁,Frankel神经功能分级包括:A级2例,B级1例,C级2例,D级19例,E级9例。SINS平均得分为11.6分,最低分8分,最高分16分。ESCC分级,1b2例,1c2例,2级13例,3级16例。术前合并内科疾病患者17例,无内科疾病患者16例,7例患者在椎体肿瘤刮除后行直视下骨水泥填塞,另外26例患者均单纯行肿瘤刮除。所有患者均行椎弓根螺钉固定,平均使用螺钉数为7.2(4~9)个。中位出血量600(150~2500)ml。中位手术时间168(94~277)min。3例患者出现了围手术期并发症。29例(87.9%)患者获得术后症状改善。结论存在硬膜外压迫的老年脊柱骨转移瘤患者,在做好围手术期准备后,采用分离手术能够在控制创伤的同时获得良好的症状改善。

Objective To explore the clinical characteristics of metastatic epidural spinal cord compression in patients aged 60 years and older accepted separation surgery.Methods We identified old patients with spinal metastases who underwent separation surgery from January 2014 to December 2018 in the 960 hospital.The data included gender,age,pathology,involvement,stability of the spine,epidural spinal cord compression,neurological function evaluation,tumor treatment,internal fixation,operative time,bleeding volume,chronic illness,and postoperative complications Statistics analyze were performed separately.Results Thirty-three patients met inclusion criteria(19 women/14 men;mean age 65.2 years,range 60-75).The Frankel neurological function classification included 2 cases of grade A,1 case of grade B,2 cases of grade C,19 cases of grade D,and 9 cases of grade E.The average SINS was 11.6 points,range 8-16 points.ESCC classification included 2 cases with stage 1b,2 cases with 1c,13 cases with 2,and 16 cases with 3.There were 17 patients with chronic illness and other 16 patients without.All patients underwent pedicle screw fixation,and the average number of screws used was 7.2(range 4-9).Only seven patients underwent bone cementation after tumor curettage under direct vision.The median amount of bleeding was 600 ml(range 150-2,500 ml).The median operation time was 168 min(range 94-277 min).Perioperative complications occurred in 3 patients after surgery.29 patients had symptomatic improvement after surgery,and the improvement rate was 87.9%.Conclusion With careful patient selection,separation surgery may achieve good symptom improvement under controllable trauma.