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目的:探讨脊柱转移瘤患者的手术切除与脊柱稳定性重建的适应证与效果。方法:2003年4月至2008年4月,收治了脊柱转移癌患者32例。肿瘤转移部位:胸椎转移22例,腰椎转移7例,颈椎转移3例。男性13例,女性19例。出现神经系统受损者27例,其中完全瘫痪者7例,不完全瘫痪者20例。全组患者均做了椎体切除、内固定术或后路椎板切除、椎管减压内固定术或前后路联合行360°脊椎切除固定一期重建脊柱稳定性。观察术后局部疼痛缓解,神经功能恢复及脊柱稳定性情况。结果:随访时间为6~60个月,32例患者中,30例术后痛疼得到缓解。27例有神经功能损害的患者中,25例术后麻痹症状改善。3例完全瘫痪的患者中,2例在减压术后ASIA分级提高了1~2个等级。术后影像学提示脊柱序列和椎间高度恢复。术后存活1年以上的患者22例,约占患者总数的69%。结论:外科切除与重建治疗转移癌所致椎体塌陷或不稳定造成严重的神经损害或机械性脊柱痛疼的外科疗效肯定,能够增加脊椎稳定性,提高生存质量。
Objective: To investigate the indications and effects of surgical resection and spinal stability reconstruction in patients with spinal metastases. Methods: From April 2003 to April 2008, 32 patients with spinal metastases were treated. Tumor metastasis: Thoracic transfer in 22 cases, lumbar metastasis in 7 cases, cervical metastases in 3 cases. 13 males and 19 females. There were 27 cases of nervous system damage, including 7 cases of complete paralysis and 20 cases of incomplete paralysis. All the patients underwent vertebral excision, internal fixation or posterior laminectomy, spinal decompression and internal fixation or anterior and posterior approach 360 ° spondylectomy to reconstruct the spinal stability. Postoperative local pain relief, neurological recovery and spinal stability were observed. Results: The follow-up time ranged from 6 to 60 months. Among 32 patients, 30 patients had pain relief after operation. Of the 27 patients with neurological impairment, 25 had improved postoperative paralysis symptoms. Of the 3 patients who were completely paralyzed, 2 had an ASIA grade of 1 to 2 increased after decompression. Postoperative imaging revealed spine sequence and intervertebral height recovery. Twenty-two patients survived more than one year, accounting for about 69% of the total number of patients. Conclusion: Surgical resection and reconstruction of the treatment of metastatic carcinoma caused by vertebral collapse or instability caused by serious nerve damage or mechanical spinal pain afflicted surgical efficacy, can increase the stability of the spine, improve the quality of life.