手术联合椎体成形术治疗多发性脊柱肿瘤

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目的探讨外科手术联合椎体成形术治疗多发性脊柱肿瘤的方法、疗效及并发症。方法2001年2月至2003年11月,采用手术联合椎体成形术治疗包括转移瘤、多发性骨髓瘤和淋巴瘤等在内的多发性脊柱肿瘤患者20例,男性13例,女性7例。病变累及2个脊椎节段者5例, 3 ~4个节段者11例, 5个或以上节段者4例。所有患者均存在神经系统损害和严重疼痛,术前Tomita评分,平均7. 2分(3~9分)。结果20例患者中17例(85% )术后疼痛得到缓解, 12例有神经功能损害的患者中, 10例术后麻痹症状改善。术前Frankel分级为B级的患者1例术后改善为C级; 1例术前FrankelA级的患者术后无明显变化。椎体成形术的并发症主要与骨水泥渗漏有关硬膜外少量渗漏2例3椎,椎旁渗漏2例2椎,沿椎旁静脉渗漏和椎间盘内渗漏各1例。结论选择适当病例,对多发性脊柱肿瘤病例采用外科手术联合椎体成形术以及综合其他治疗方法,可以更好的缓解疼痛,改善神经症状,提高生存质量。 Objective To investigate the methods, efficacy and complications of surgical operation combined with vertebroplasty in the treatment of multiple spinal tumors. Methods From February 2001 to November 2003, 20 patients with multiple spinal tumors including metastases, multiple myeloma and lymphoma were treated with operation combined with vertebroplasty. There were 13 males and 7 females. Lesions involving 2 spine segments in 5 cases, 3 to 4 segments in 11 cases, 5 or more segments in 4 cases. All patients had neurologic impairment and severe pain. The preoperative Tomita score averaged 7.2 (3-9). Results Postoperative pain was relieved in 17 of 20 patients (85%), and in 10 of 12 patients with neurological impairment, postoperative symptoms of paralysis were improved. One patient with preoperative Frankel grade B had an improvement of grade C postoperatively and one patient with preoperative Frankel A grade had no significant postoperative change. The complications of vertebroplasty were mainly associated with leakage of cement, 2 cases of epidural leakage, 2 cases of 3 vertebral paravertebral leakage, 2 cases of 2 vertebrae, paravertebral vein leakage and intradiscal leakage of 1 case. Conclusion Select the appropriate cases, the use of surgical operations combined with vertebroplasty and other treatment of multiple spinal tumors, can better relieve pain, improve neurological symptoms and improve quality of life.
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