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目的探讨一期后路病灶切除、360°环脊髓减压、钛网骨水泥重建内固定治疗胸腰椎转移性肿瘤的临床疗效。方法回顾性分析2011-07-2015-03经上述方法治疗的15例胸腰椎转移瘤临床资料。均行一期后路病灶切除、360°环脊髓减压、钛网骨水泥重建内固定术。观察并记录手术时间、术中失血、术后并发症、生存时间;采用VAS评分、SF-36评分、ASIA分级对患者的疼痛程度、生活质量和神经功能进行评价。结果本组患者平均手术时间(297.2±79.1)min,术中出血量(889.3±368.1)ml。术前、术后1个月、末次随访的VAS评分分别为(7.1±1.2)分、(2.1±1.0)分、(2.9±1.5)分,术后各时间点与术前比较,均具有统计学差异(P<0.05)。术前神经功能ASIA分级D级2例,E级13例,末次随访E级12例,D级1例,B级2例。健康调查简表(the MOS item short from health survey,SF-36)评分术前(63.1±7.7)分,术后6个月或末次随访(生存期未达6个月者)(79.8±11.4)分,与术前比较,差异有统计学意义(P<0.05)。患者中位生存时间15个月,围术期死亡1例,术后6个月内死亡3例,术后1年内死亡6例,术后2年内死亡9例,存活2年以上1例。至末次随访,共6例患者存活。结论一期后路病灶切除、360°环脊髓减压、钛网骨水泥重建联合内固定治疗胸腰椎转移性肿瘤,可明显改善患者神经症状和生存质量,同时,可为患者争取获得更多辅助治疗的机会,达到局部病变的中长期控制。
Objective To investigate the clinical effect of a posterior lesion resection, 360 ° circular spinal cord decompression and titanium mesh cemented reconstruction internal fixation for thoracolumbar metastasis. Methods The clinical data of 15 cases of thoracolumbar metastases treated by the above method were retrospectively analyzed from 2011-07-2015-03. All patients underwent resection of a posterior lesion, 360 ° cricothyroid decompression and titanium mesh cement reconstruction and internal fixation. Observe and record the operative time, intraoperative blood loss, postoperative complications, survival time; the use of VAS score, SF-36 scores, ASIA grading of the severity of pain and quality of life of patients with neurological evaluation. Results The mean operative time (297.2 ± 79.1) min and the amount of intraoperative blood loss (889.3 ± 368.1) ml in this group of patients. The VAS score at the last follow-up one month and at the last follow-up were (7.1 ± 1.2) points, (2.1 ± 1.0) and (2.9 ± 1.5) points respectively. There were statistically significant differences in postoperative VAS scores Learning difference (P <0.05). There were 2 cases of preoperative neurological function ASIA grade D, 13 cases of grade E, 12 cases of grade E at last follow-up, 1 case of grade D and 2 cases of grade B. The score of the MOS item short from health survey (SF-36) was (63.1 ± 7.7) points preoperatively, 6 months or the last follow-up (survival less than 6 months) (79.8 ± 11.4) Points, compared with preoperative, the difference was statistically significant (P <0.05). The median survival time was 15 months, 1 patient died during perioperative period, 3 died within 6 months after operation, 6 died within 1 year after operation, 9 died within 2 years after operation and 1 case survived for more than 2 years. To the last follow-up, a total of 6 patients survived. Conclusion a posterior excision, fixation within thoracolumbar metastatic tumors, titanium mesh reconstruction of bone cement joint ring cord 360 ° under reduced pressure, can significantly improve the quality of life in patients with neurological symptoms and, at the same time, can assist the patient for more Treatment of the opportunity to reach the long-term control of local disease.