摘要
目的探讨骨水泥在单节段胸腰椎转移瘤后路手术中的应用价值。方法2004年3月-2008年12月后方入路手术治疗单节段胸腰椎转移性肿瘤16例，原发灶为肺癌4例，乳腺癌3例，肝癌3例，前列腺癌3例，肾癌1例，来源不明2例。术前采用Tokuhashi评分系统对患者进行评估，术中均采用骨水泥联合椎弓根螺钉重建脊柱稳定性。Tokuhashi评分〈9分者10例，行病灶切除或刮除骨水泥填塞，Tokuhashi评分I〉9分者6例，行全脊椎切除骨水泥重建椎体。结果所有患者获得完整随访，随访时间为3—42个月，平均18．2个月，11例死亡。术后疼痛缓解13例，神经功能改善11例。未出现骨水泥放热效应引起的神经功能受损，未发现有骨水泥下沉、椎节塌陷及向前成角。1例骨水泥填塞术后3个月出现松动，但并未引起神经压迫症状。结论在单节段胸腰椎转移性肿瘤后路手术治疗中利用骨水泥进行椎体重建可以减小手术创伤、提高生存质量。
Objective To explore the clinical effects of the bone cement employed in the posterior approach surgical treat- ment of the single segment thoracic and lumbar spinal metastases. Methods A retrospective review of 16 patients that underwent posterior resection for the single segment thoracic or lumbar spinal metastases from March 2004 to December 2008 was undertaken. There were lung carcinoma of primary focus in 4 cases, breast carcinoma in 3 cases, hepatoma in 3 cases, prostatic carcinoma in 3 cases and renal carcinoma in 1 case and unknown origin in 2 cases. Tokuhashi score system was used to evaluate the patients preoperatively and bone cement combined with posterior pedicle screw instrumentation was used to reconstruct vertebral body. Ten patients whose Tokuhashi scores were 〈 9 underwent excision of focus or bone cement packing. Six patients whose Tokuhashi scores were ≥9 underwent excision of total spine and bone cement reconstruction. Results All the patients were followed up, and the period of follow-up ranged from 3 months to 42 months with a mean time of 18.2 months. Eleven cases died. After the operation, the pain was relieved in 13 cases and the nerve compression symptoms were improved in 11 cases. No nerve function impairment caused by exothermic effect of bone cement. The internal fixation was finn with no bone coment sinked, no vertebral body collapse and no pedicel break. Loosening of bone cement packing occurred in 1 case 3 months postoperatively. Conclusion Bone cement can be used in reconstruction and stabilization after posterior approach surgieal treatment of the thoracic or lumbar spinal metastases. This technique has the advantage of less operation wound and can improve life quality.
出处
《脊柱外科杂志》
2009年第6期332-335,共4页
Journal of Spinal Surgery
关键词
胸椎
腰椎
骨肿瘤
骨代用品
Thoracic vertebrae
Lumbar Vertebrae
Bone neoplasms
Bone substitutes
