摘要
目的探讨脊柱转移性肿瘤的临床特点、手术治疗策略及其预后。方法对103例脊柱转移性肿瘤患者的临床特点、手术适应证、外科治疗方式及其预后进行分析。结果术后随访6个月～5年,85例患者术后局部疼痛、神经根痛缓解甚至消失,脊髓压迫症状改善或缓解;术后6个月、1、2、3、4年的生存率分别为97.1%、90.3%、44.7%、29.1%、8.7%。结论脊柱转移性肿瘤患者多数表现为局部疼痛,部分患者有脊髓、神经根损害的表现。手术必须考虑全身情况,限于脊柱不稳、神经功能进行性损害、局部疼痛剧烈且原发病灶已积极处理、或原发灶不明手术作为明确病理诊断以指导进一步治疗的患者。根据肿瘤侵犯部位、患者耐受手术情况、预期寿命等选择前路、后路或前后联合入路的一期或二期手术。手术能够稳定和重建脊柱,减轻或缓解疼痛,维持或改善神经功能,从而改善患者的生活质量。
Objective To study the clinical features,surgical treatments and the prognosis of the103patients with the metastatic tu mors in the spine.Methods From Jan.1996to Dec.2001,103cases were treated by operation in our department,there were62males and41females,aging from33to79years old(average,59years).The lesions were located at cervical spines in34cases,thoracic spines in39,lumbar spines in25and sacrum in5.The patients underwent anterior,posterior,combined or staged antero-posterior operations based on the location of lesions in the spine.Most of the patients were adopted vertebral recon-struction and internal fixation depending on the conditions.Preoperative clinical evaluation included of gen-eral condi tions,X-ray films,CT scan,MRI and ECT in order to decide the endurance of the patient to the sur gi cal treatment.The operation was only considered when the patient could have the ex pected survival time more than6months.Operative indications,surgical methods and prognosis were analyzed and summa -rized.Re sults The postopera tive follow-up ranged from6months to5years.No death related to the op-eration.Eighty-five of 103cases had partial or even complete relief of local pain and radiculopathy,54cases were im proved in neu rological status caused by spinal cord compression.The postoperative survival rates at6months,one year,two years,three years and four years intervals were97.1%,90.3%,44.7%,29.1%and8.7%respectively,9patients survived more than4years.Conclusion Local pain was the predomi nant symptom in metastatic tu mor of spine,and some of them suffered from spinal cord and nerve compromise.The surgical treatments for the spinal metastatic diseases were indicated depending spinal instability,progressive neurological deteriora tion,in tractable pain,or the need for histological diagnosis.The most im por tant factor being consid-ered was the patient's condition when operative treatment was decided.The anterior,posterior,combined or staged antero-poste rior operations were influenced by l
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2003年第1期14-18,共5页
Chinese Journal of Orthopaedics
