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目的探讨单纯后路经椎弓根椎体次全切除内固定联合人工椎体置换治疗胸腰椎转移瘤的临床疗效。方法 2007年1月至2010年3月,对21例胸腰椎转移瘤进行单纯后路经椎弓根椎体次全切除、人工椎体置换及内固定术。男9例,女12例;平均年龄58岁(39～77岁)。病变位于胸椎16例,腰椎5例。术前VAS评分平均7.4分(5～10分);术前Frankel脊髓功能分级:C级3例,D级6例,E级12例;术前ECOC功能分级2级1例,3级1 8例,4级2例。结果所有患者无术中死亡,平均手术时间3.5h(2-5h)。术中出血平均2150ml(800～5000ml)。1例转移瘤患者术后2周死于多器官功能衰竭,20例患者术后VAS评分平均降至3.1分(1～4.5分),1例Frankel C级没有改变,1例C级改善为D级,6例D级均改善为E级。3例患者(14.3%)于术后半年至1年复发再次手术。最后一次随访时,20例患者平均随访13个月(3-24个月),其中13例患者死于原发疾病(平均生存10个月),其余存活患者ECOG功能分级为1～3级。结论单纯后路经椎弓根椎体次全切除内固定联合人工椎体置换术减压充分,症状改善明显,可有效纠正脊柱后凸畸形,重建脊椎前后柱稳定性,改善骨转移瘤患者的生活质量。
Objective To investigate the clinical effect of simple posterior pedicle screwed total internal fixation combined with artificial vertebral body replacement in the treatment of thoracolumbar metastases. Methods From January 2007 to March 2010, 21 cases of thoracolumbar metastases were treated by simple posterior pedicle subtotal vertebrectomy, artificial vertebral body replacement and internal fixation. 9 males and 12 females; mean age 58 years (39-77 years old). Lesions in the thoracic 16 cases, 5 cases of lumbar. The preoperative VAS score was 7.4 points (range, 5 to 10). The preoperative Frankel spinal cord function grading was 3 cases of grade C, 6 cases of grade D and 12 cases of grade E. The preoperative ECOC function was grade 2 in 1 case and grade 3 was 18 Cases, 4 cases in 2 cases. Results All patients died without surgery, the average operation time 3.5h (2-5h). Intraoperative bleeding average 2150ml (800 ~ 5000ml). One patient with metastatic disease died of multiple organ failure 2 weeks after surgery. The VAS score of the 20 patients dropped to an average of 3.1 (range, 1 to 4.5) postoperatively. One patient had no changes in Frankel C grade and one C grade improved to D Grade, 6 cases of D grade improved to E grade. Three patients (14.3%) relapsed after surgery for six months to 1 year reoperation. At the last follow-up, 20 patients were followed up for an average of 13 months (3-24 months), 13 of whom died of primary disease (mean survival 10 months) and the remaining survivors were classified as grade 1 to 3. Conclusions Simple posterior pedicle vertebral body subtotal resection and internal fixation combined with artificial vertebral body replacement has sufficient decompression and obvious improvement of symptoms, which can effectively correct kyphosis, reconstruct the stability of the anterior and posterior spine of the spine, and improve the prognosis of patients with bone metastases Quality of Life.