目的:探討脊柱轉(zhuǎn)移瘤患者的手術切除與脊柱穩(wěn)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(zhuǎn)移癌患者32例。腫瘤轉(zhuǎn)移部位:胸椎轉(zhuǎn)移22例,腰椎轉(zhuǎn)移7例,頸椎轉(zhuǎn)移3例。男性13例,女性19例。出現(xiàn)神經(jīng)系統(tǒng)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(nèi)固定術或后路椎板切除、椎管減壓內(nèi)固定術或前后路聯(lián)合行360°脊椎切除固定一期重建脊柱穩(wěn)定性。觀察術后局部疼痛緩解,神經(jīng)功能恢復及脊柱穩(wěn)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(jīng)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(shù)的69%。結論:外科切除與重建治療轉(zhuǎn)移癌所致椎體塌陷或不穩(wěn)定造成嚴重的神經(jīng)損害或機械性脊柱痛疼的外科療效肯定,能夠增加脊椎穩(wěn)定性,提高生存質(zhì)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(zhuǎn)移腫瘤. 華西醫(yī)學, 2009, 24(1): 90-93. doi: 復制
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