摘要
目的 观察上胸椎单椎节脊柱转移瘤患者行一期后入路开放手术后疼痛和脊髓神经功能改善情况,探讨其在提高患者生存质量中的作用。方法 上胸椎单椎节脊柱转移瘤患者41例,术前改良Tokuhashi评分12~15分者25例行后入路全脊椎切除重建术,9~11分者16例行后入路姑息手术(病椎部分切除内固定术或联合椎体成形术)。记录围术期并发症发生情况;分别于术前及术后1、3、6个月及末次随访时采用疼痛视觉模拟评分(visual analogue scale, VAS)评估疼痛程度,采用美国脊髓损伤协会(American Spinal Injury Association, ASIA)分级评估脊髓神经功能,采用Karnofsky功能状态评分(Karnofsky performance scale, KPS)评估生存质量。随访2年,记录患者生存情况。结果 (1)41例一期手术均顺利完成,术后X线检查提示脊柱稳定。行全脊椎切除重建术者围术期发生下肢深静脉血栓1例、切口脂肪液化1例、胸腔积液13例,行姑息手术者发生切口脂肪液化2例、胸腔积液2例,均经对症治疗后好转。随访至2023年1月,随访8~24(16.49±4.99)个月,行姑息手术者死亡2例,行全脊椎切除重建术者无死亡病例。(2)全脊椎切除重建术后1、3、6个月及末次随访时VAS评分[(4.08±1.19)、(3.80±1.12)、(2.12±0.89)、(1.80±1.00)分]均低于术前[(7.32±0.90)分](P<0.05);姑息手术后1、3、6个月及末次随访时VAS评分[(4.31±1.14)、(4.01±0.86)、(2.19±0.99)、(1.56±1.32)分]均低于术前[(7.44±0.77)分](P<0.05);所有患者术后1、3、6个月及末次随访时VAS评分依次降低(P<0.05)。(3)行全脊椎切除重建术和姑息手术者KPS≥80分、ASIA分级D~E级比率在术后3、6个月及末次随访时均高于术前(P<0.05),术后1个月与术前比较差异无统计学意义(P>0.05)。结论 上胸椎单椎节脊柱转移瘤患者根据改良Tokuhashi评分行一期后入路全脊椎切除重建术或姑息手术均可有效缓解疼痛,改善脊髓神经功能,提高生存质
Objective To observe the alleviation of pain and the improvement of spinal cord function in patients with single upper thoracic spinal metastatic tumor after open surgery via one-stage posterior approach,and to explore its role in improving the quality of life.Methods In 41 patients with single upper thoracic spinal metastatic tumor,25 patients with preoperative revised Tokuhashi score of 12 to 15 underwent total spinal resection and reconstruction via posterior approach,and 16 patients with 9 to 11 scores underwent partial vertebral resection and internal fixation or combined vertebroplasty via posterior approach.The incidence of perioperative complications was recorded.Before surgery,1,3 and 6 months after surgery,and at the final follow-up,the visual analogue scale(VAS),the American Spinal Injury Association(ASIA)Impairment Scale,and the Karnofsky performance scale(KPS)were done to evaluate the pain,the spinal cord function and the quality of life,respectively.The patients were followed up for 2 years to record the survival.Results(1)All 41 patients were performed one-stage surgeries successfully,and the postoperative X-ray examination indicated that the spine was stable.The postoperative complications included deep vein thrombosis of lower limb in 1 patient,incision fat liquefaction in 1 and pleural effusion in 13 of the 25 patients receiving total spinal excision,and incision fat liquefaction in 2 and pleural effusion in 2 of the 16 patients receiving palliative surgery,all of which were alleviated after symptomatic treatment.The patients were followed up till January 2023,with a follow-up time of 8 to 24(16.49±4.99)months.Two patients receiving palliative surgery died and no death occurred in patients receiving total spinal excision.(2)The VAS score was lower 1,3 and 6 months after total spinal resection and at the final follow-up(4.08±1.19,3.80±1.12,2.12±0.89,1.80±1.00)than that before surgery(7.32±0.90)(P<0.05),and was also lower 1,3 and 6 months after palliative surgery and at the final follow-up(4
作者
张瑜哲
钟楚楠
刘继军
罗建平
杨彬
王林
ZHANG Yu-zhe;ZHONG Chu-nan;LIU Ji-jun;LUO Jian-ping;YANG Bin;WANG Lin(Department of Orthopedics,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China)
出处
《中华实用诊断与治疗杂志》
2023年第5期494-498,共5页
Journal of Chinese Practical Diagnosis and Therapy
基金
河南省医学科技攻关计划省部共建项目(2018010024)。
