在胸腰椎转移瘤分离手术中应用短节段骨水泥强化椎弓根螺钉固定的临床研究

Clinical study on short-segment bone cement reinforced pedicle screw fixation in separation surgeries for thoracolumbar spinal metastatic tumor

目的:探讨在胸腰椎转移瘤分离手术中应用骨水泥强化椎弓根螺钉固定的临床疗效。方法:回顾性分析2018年2月~2019年10月于我院行分离手术治疗的伴有硬脊膜外脊髓压迫症(epidural spinal cord compression,ESCC)的胸腰椎转移性肿瘤患者59例,其中男25例,女34例,年龄56.2±7.5岁(45~76岁)。所有患者均采用骨水泥强化椎弓根螺钉固定,共置入236枚螺钉。统计手术时间、术中失血量、输血量、术后住院天数,患者术前、术后3个月的Frankel脊髓损伤分级,患者术前、术后7d、3个月及末次随访的疼痛视觉模拟评分(visual analogue scale,VAS)及Karnofsky功能评分,围手术期相关并发症情况。收集患者术前、术后7d及末次随访时手术节段正侧位X线片,随访观察有无内固定失败及手术节段矢状位Cobb角的变化。结果:患者随访时间为18.3±3.9个月(5~34个月);患者手术时间为169.0±23.7min(125~210min),术中出血量为535±120.0ml(200~1300ml),术中输少浆血1.2±0.6u(0~6u)、血浆105±32ml(0~400ml);术后住院时间6.5±2.3d(5~11d)。术中发生骨水泥渗漏2例,均为椎前静脉少量渗漏,暂停注射后渗漏未进展,术后无不良反应;脑脊液漏1例,患者俯卧位以及补液等对症处理后痊愈;伤口愈合不良2例,予以清创缝合后伤口愈合。术后VAS评分、Frankel分级、Karnofsky功能评分与术前相比均有显著性改善(P<0.05)。无内固定失败,末次随访时手术节段Cobb角较手术后即刻无显著性差异(22.5°±2.1°vs 21.2°±1.8°,P>0.05)。结论:对伴有ESCC的脊柱转移瘤患者行分离手术时,应用骨水泥强化椎弓根螺钉可以提供更加坚强的脊柱稳定性。

Objectives:To investigate the clinical efficacy of bone cement reinforced pedicle screw fixation in separation surgeries for the treatment of thoracolumbar spinal metastasis.Methods:A retrospective analysis was performed on the patients suffered from thoracolumbar metastasis with epidural spinal cord compression(ESCC)and received separation surgeries in our hospital from February 2018 to October 2019.A total of 59 patients were recruited,including 25 males and 34 females,aged 45-76 years(averaged 56.2±7.5 years).Bone cement reinforced pedicle screw fixation was applied in all the patients,and a total of 236 bone cement reinforced pedicle screws were implanted.The operative time,intraoperative blood loss,transfusion volume,postoperative hospitalization days and perioperative complications were recorded.Frankel grading at preoperation and postoperative 3 months,visual analogue scale(VAS)and Karnofsky score before surgery and at postoperative 7d and 3 months,and final follow-up were recorded and analyzed.The preoperative,postoperative 7d and final follow-up anteroposterior and lateral X-ray images of the operated segments were collected,and the status of internal fixation and sagittal Cobb angle changes were observed and recorded.Results:The follow-up period was 18.3±3.9 months(5-34 months);operative time was 169.0±23.7min(125-210min),intraoperative blood loss was 535±120.0ml(200-1300ml),transfusion of red blood cell and plasma was 1.2±0.6u(0-6u)and 105±32ml(0-400ml),respectively;the postoperative hospitalization days were 6.5±2.3d(5-11d).Bone cement leakage occurred in 2 cases,both were of small amount through the anterior vertebral vein,which stopped progressing once suspended injection with no adverse reactions after operation;CSF leakage occurred in 1 case,which was cured with prone position and fluid infusion;and impaired wound healing occurred in 2 cases,which healed after debridement and suture.VAS score,Frankel grading and Karnofsky score at different postoperative time were significantly improved compared with those before surgery(P<0.05).None internal fixation failure occured,and no significant difference was found between the Cobb angles of operative segments at final follow-up and immediate postoperatively(22.5°±2.1°vs 21.2°±1.8°,P>0.05).Conclusions:Bone cement reinforced pedicle screw fixation can provide much stronger spinal stability in separation surgeries for patients with thoracolumbar spinal metastatic tumors and ESCC.