目的:探討脊柱轉移瘤患者的手術切除與脊柱穩定性重建的適應證與效果。方法:2003年4月至2008年4月,收治了脊柱轉移癌患者32例。腫瘤轉移部位:胸椎轉移22例,腰椎轉移7例,頸椎轉移3例。男性13例,女性19例。出現神經系統受損者27例,其中完全癱瘓者7例,不完全癱瘓者20例。全組患者均做了椎體切除、內固定術或后路椎板切除、椎管減壓內固定術或前后路聯合行360°脊椎切除固定一期重建脊柱穩定性。觀察術后局部疼痛緩解,神經功能恢復及脊柱穩定性情況。結果:隨訪時間為6~60個月,32例患者中,30例術后痛疼得到緩解。27例有神經功能損害的患者中,25例術后麻痹癥狀改善。3例完全癱瘓的患者中,2例在減壓術后ASIA分級提高了1~2個等級。術后影像學提示脊柱序列和椎間高度恢復。術后存活1年以上的患者22例,約占患者總數的69%。結論:外科切除與重建治療轉移癌所致椎體塌陷或不穩定造成嚴重的神經損害或機械性脊柱痛疼的外科療效肯定,能夠增加脊椎穩定性,提高生存質量。
引用本文:
張智,葉永杰,鄭佳壯,康小平. 外科切除與重建治療脊柱轉移腫瘤. 華西醫學, 2009, 24(1): 90-93. doi:
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1. |
Weigel B,Maghsudi M,Neumann C,et al.Surgical management of symptomatic spinal metastases.Postoperative outcome and quality of life[J].Spine,1999,24:2240-2246..
|
2. |
FeizErfan I,Rhines LD,Weinberg JS.The role of surgery in the management of metastatic spinal tumors[J].Semin Oncol,2008,35(2):108-117..
|
3. |
Fujimaki Y,Tsuchiya H,Kawahara N,et al.Surgical treatment for metastatic bone tumor[J].Clin Calcium,2006,16(4):647-654..
|
4. |
Manabe J,Kawaguchi N,Matsumoto S,et al.Surgical treatment of bone metastasis:indications and outcomes[J].Int J Clin Oncol,2005,10(2):103-111..
|
5. |
Bilsky MH,Boakye M,Collignon F,et al.Operative management of metastatic and malignant primary subaxial cervical tumors[J].J Neurosurg Spine,2005,2(3):256-264..
|
6. |
Chen YJ,Hsu HC,Chen KH,et al.Transpedicular partial corpectomy without anterior vertebral reconstruction in thoracic spinal metastases[J].Spine,2007 Oct 15;32(22):E6236..
|
7. |
劉忠軍,黨耕町,馬慶軍,等.脊柱腫瘤的全脊椎切除術及脊柱穩定性重建[J].中華骨科雜志,2001,21(11):646-649..
|
8. |
Vrionis FD,Small J.Surgical management of metastatic spinal neoplasms[J].Neurosurg Focus,2003,15(5):E12..
|
9. |
Tomita K,Kawahara N,Kobayashi T,et al.Surgical strategy for spinal metastases[J].Spine,2001,26:298-306..
|
10. |
Boriani S,Biagini R,De Iure F,et al.En bloc resections of bone tumors of the thoracolumbar spine.A preliminary report on 29 patients[J].Spine,1996,21(16):1927-1931.
|
- 1. Weigel B,Maghsudi M,Neumann C,et al.Surgical management of symptomatic spinal metastases.Postoperative outcome and quality of life[J].Spine,1999,24:2240-2246..
- 2. FeizErfan I,Rhines LD,Weinberg JS.The role of surgery in the management of metastatic spinal tumors[J].Semin Oncol,2008,35(2):108-117..
- 3. Fujimaki Y,Tsuchiya H,Kawahara N,et al.Surgical treatment for metastatic bone tumor[J].Clin Calcium,2006,16(4):647-654..
- 4. Manabe J,Kawaguchi N,Matsumoto S,et al.Surgical treatment of bone metastasis:indications and outcomes[J].Int J Clin Oncol,2005,10(2):103-111..
- 5. Bilsky MH,Boakye M,Collignon F,et al.Operative management of metastatic and malignant primary subaxial cervical tumors[J].J Neurosurg Spine,2005,2(3):256-264..
- 6. Chen YJ,Hsu HC,Chen KH,et al.Transpedicular partial corpectomy without anterior vertebral reconstruction in thoracic spinal metastases[J].Spine,2007 Oct 15;32(22):E6236..
- 7. 劉忠軍,黨耕町,馬慶軍,等.脊柱腫瘤的全脊椎切除術及脊柱穩定性重建[J].中華骨科雜志,2001,21(11):646-649..
- 8. Vrionis FD,Small J.Surgical management of metastatic spinal neoplasms[J].Neurosurg Focus,2003,15(5):E12..
- 9. Tomita K,Kawahara N,Kobayashi T,et al.Surgical strategy for spinal metastases[J].Spine,2001,26:298-306..
- 10. Boriani S,Biagini R,De Iure F,et al.En bloc resections of bone tumors of the thoracolumbar spine.A preliminary report on 29 patients[J].Spine,1996,21(16):1927-1931.