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目的脊柱转移瘤可引起顽固性疼痛及脊髓压迫,其外科治疗仍存在许多争议,探讨脊柱转移瘤外科治疗的临床效果。方法自1998年7月～2001年7月,北京大学人民医院骨肿瘤科手术治疗脊柱转移瘤患者62例,包括颈椎转移6例,胸椎转移37例,腰椎转移19例。无明显神经系统受累者19例;出现神经系统受损者43例,其中完全瘫痪者19例,不完全瘫痪者24例。病变累及一个脊椎节段者43例,二个脊椎节段者14例,三个脊椎节段者5例。结果62例患者中,58例(94%)术后疼痛得到缓解。43例有神经功能损害的患者中,33例术后麻痹症状改善。25例术前膀胱及直肠功能受损的患者中,术后12例膀胱及直肠功能明显改善。术前FrankelA、B级的患者,5例术后恢复到E级或D级,9例改善为C或D级。结论从肢体功能减退到完全瘫痪所经历的时间是最重要的预后因素,在48h内完全瘫痪为预后不良的重要因素;膀胱和直肠功能的完全丧失也提示预后不良。甲状腺癌和乳腺癌的脊柱转移一般预后较好,肺癌和肝癌的脊柱转移通常存活期较短。
Purpose Spinal metastases can cause intractable pain and spinal cord compression. There are still many controversial surgical treatments to explore the clinical effect of surgical treatment of spinal metastases. Methods From July 1998 to July 2001, 62 patients with spinal metastases underwent surgical treatment of bone tumor at Peking University People’s Hospital, including 6 cases of cervical spine metastasis, 37 cases of thoracic spine metastasis and 19 cases of lumbar spine metastasis. No obvious nervous system involvement in 19 cases; there were 43 cases of nervous system damage, including 19 cases of complete paralysis, 24 cases of incomplete paralysis. Lesions involving a spine segment in 43 cases, two spine segments in 14 cases, three spine segments in 5 cases. Results Of 62 patients, 58 (94%) postoperative pain relief. Among the 43 patients with neurological impairment, 33 had improved postoperative paralysis symptoms. Of the 25 patients with preoperative bladder and rectal impaired function, the bladder and rectum function improved significantly after operation in 12 patients. Preoperative FrankelA, B-class patients, 5 patients recovered to E or D grade, 9 patients improved to C or D grade. Conclusions The time from exacerbation of limbs to complete paralysis is the most important prognostic factor. Complete paralysis within 48 hours is an important factor in poor prognosis. The complete loss of bladder and rectal function also suggests a poor prognosis. Spinal metastases from thyroid and breast cancer generally have a better prognosis, and spinal metastases from lung cancer and liver cancer usually have shorter survival.