脊柱转移肿瘤的外科治疗

Surgical Treatment of the Spinal Metastatic Tumors

目的 :探讨脊椎转移肿瘤的手术适应证 ,手术方法及其预后。方法 :统计分析 1992年 1月～ 2 0 0 3年 1月收治的 92例脊椎转移肿瘤患者 ,其中男性 5 8例 ,女性 3 4例 ,年龄 18～ 82岁 ,平均年龄 5 7 2岁。术前存在截瘫者 2 7例 ,FrankelA级 4例 ,B级 8例 ,C级 8例 ,D级 5例 ,E级 2例。结果 :随防 6个月～ 11年 ,平均 4年 3个月。 3 1例患者得到随访 ,其中 2 7例死亡 ,4例生存。疼痛明显缓解 2 5 /2 9例。术后Franrel分级A级 1例、B级 1例、C级 2例、D级 4例、E级 10例 ,9例恢复正常 ,术后脊髓功能改善率 2 5 /2 7。结论 :手术能够重建脊椎的稳定性 ,缓解疼痛 ,维护或改善患者的神经功能 ,从而改善脊椎转移肿瘤患者的生存质量。

Objective:To study the indication and methods of surgical treatment and the prognosis of patients with the metastatic tumors in the spine.Methods:The study presented a retrospective analysis of 92 patients with spinal metastatic tumor from Jan.1992 to Jan.2003.In the group,there were 58 males and 34 females,aging from 18～82 years old with the mean age of 57.2 years.Frankel grade was preoperatively evaluated as grade A 4 cases,grade B 8 cases,grade C 8 cases,grade D 5 cases and grade E 2 cases.Results:The period of follow-up ranged from 6 months to 11 years with a mean of 4 years and 3 months.Thirty-one of 42 patients were followed-up,27 cases died and 4 cases suvived.The postoperative survival rates over 6 months,one year,two years were 20 cases,12 cases,2 cases respectively.The pain was relieved in 25/29 cases,getting off bed to walk 19/24 cases,local recurred in 3 cases.Postoperative Frankel grade was classified as grade A 1 case,B 1 case,C 2 cases,D 4 cases and E 10 cases,completely recovered 9 cases,recover rate was 25/27.Conclusion:Surgical intervention can stabilize and reconstruct the spine,relieve pain,maintain or improve the neurological status of the patients,thus improve the life qualitis of patients.