摘要
目的探讨后路姑息性椎板减压椎弓根螺钉内固定联合病变椎体骨水泥成形术治疗胸腰椎转移瘤的临床疗效。方法回顾性分析2017年8月至2019年12月我院收治的胸腰椎转移瘤致胸腰背部疼痛、双下肢出现神经压迫症状的患者21例,其中男9例,女12例;年龄45~76岁,平均(58.8±7.84)岁。所有患者采用经后路姑息性肿瘤切除、椎管减压,椎弓根螺钉内固定系统重建脊柱序列稳定,病变椎体经椎弓根注入骨水泥。评价术前1 d、术后1周及末次随访时疼痛视觉模拟评分(visual analogue scale,VAS)及Oswestry功能障碍指数(Oswestry disability index,ODI),评估患者胸腰背部疼痛及生活质量改善情况。结果所有21例患者均顺利完成手术,肿瘤病变椎体强化过程中发生骨水泥渗漏7例,无放热效应及毒性反应引起的并发症。所有患者均获得随访,随访时间为6~12个月,平均(9.0±1.5)个月。术后胸腰背部疼痛明显缓解,VAS由术前(8.40±1.28)分下降至术后1周(2.52±0.60)分,末次随访时为(2.86±1.04)分;ODI由术前(69.43±7.45)%下降至术后1周(24.16±4.41)%,末次随访时为(26.48±5.22)%。术后胸腰背痛VAS、ODI与术前相比明显改善,差异均有统计学意义(P<0.05)。无内固定松动、断裂或拔出,骨水泥无移位。肿瘤局部复发4例,其中1例术后8个月随访时Frankel分级为B级,未再次手术;另外3例有神经根压迫症状,继续行局部放疗或化疗。结论后路姑息性椎板减压椎弓根螺钉内固定联合病变椎体骨水泥成形术,能明显缓解晚期胸腰椎转移瘤患者疼痛症状,改善功能,提高生活质量,该术式可获得满意的短期疗效。
Objective To explore the clinical effect of posterior palliative decompression and pedicular screws fixation combined with vertebroplasty in treatment of thoracolumbar spinal metastases.Methods From Aug.2017 to Dec.2019,a total of 21 patients(9 men and 12 women)with thoracolumbar spinal metastases were treated in our department,with an average age of(58.8±7.84)years(range:45~76 years).All patients had nervous system damage and severe thoracolumbar back pain.They were treated with the surger of palliative resection of the debulk tumor,decompression of the spinal cord,insertion of the pedicle screws system to restore the stability and injection of bone cement in the vertebra of tumor.Visual analogue scale(VAS)and Oswestry dysfunction index(ODI)were applied to analyze the improvement of the back pain and life quality 1 day before surgery,1 week postoperatively and at the last follow-up.Results All the operations were successfully completed.7 patients had bone cement leakage in the procedure of vertebroplasty,and complications due to heat-induced effects and toxicity did not occur.All the 21 patients were followed up and the average follow-up time was(9.0±1.5)months(range:6~12 months).The symptoms of thoracolumbar back pain were instantly relieved after operation.The scores of VAS decreased significantly from(8.40±1.28)points preoperatively to(2.52±0.60)1 week postoperatively,and(2.86±1.04)points at the last follow-up.There were significant decrease in ODI scores from(69.43±7.45)points preoperatively to(24.16±4.41)points 1 week postoperatively and(26.48±5.22)points at the last follow-up.The difference of the VAS scores and ODI scores in 1 week postoperatively and at the last follow-up were statistically significant comparing with that preoperatively(P<0.05).There was no loosening,fracture or pull-out of the screw,and no migration of the bone cement.All patients had neurofunction improved at least one Frankel grade after surgery.Four patients had local recurrence,of which 1 patient had a Frankel grade B at the 8 months follow-up after surgery and was not reoperated.The other three patients,who had symptoms of nerve root compression,continued to receive local radiotherapy or chemotherapy.Conclusion The methods of posterior palliative decompression and pedicular screws fixation combined with vertebroplasty in treatment of thoracolumbar spinal metastases can efficiently reduce the thoracolumbar back pain and improve patients’life quality with advanced cancer.This method gains satisfactory short-term clinical outcomes.
作者
吴学元
郝崔培
靳占奎
常彦海
孙正明
刘时璋
易智
Wu Xueyuan;Hao Cuipei;Jin Zhankui(Shaanxi Provincial People’s Hospital,Xi’an 710068,China)
出处
《实用骨科杂志》
2021年第4期300-305,共6页
Journal of Practical Orthopaedics
基金
陕西省自然科学基础研究计划项目(2019JM-517)。
作者简介
吴学元(1981-),男,副主任医师,陕西省人民医院,710068;通讯作者:常彦海。
