| 开放微波消融联合椎体成形和钉棒系统内固定治疗胸腰椎转移瘤的临床观察 |
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投稿时间：2019-04-11 修订日期：2019-06-23
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| 期刊信息：《中国骨伤》年，第卷，第期，第-页 |
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| 中文摘要:目的：探讨开放微波消融联合椎体成形、钉棒系统内固定在胸腰椎转移性肿瘤治疗中的初步临床效果。方法： 对2014年1月至2016年1月我科收治的12例胸腰椎转移癌行开放微波消融联合椎体成形、钉棒系统内固定治疗的患者进行随访,其中男性6例,女性6例；年龄30～75岁,平均55.6岁。转移癌类型：肺转移癌5例,乳腺转移癌2例,甲状腺转移癌2例,肾转移癌2例,肝转移癌1例；转移部位：胸椎转移癌7例、腰椎转移癌5例。Tomita 预后评分主要集中在 3～6 分。脊髓神经功能按ASIA分级: C级3例,D级1例,E级8例。术前疼痛视觉模拟评分(VAS评分)为(8.3±0.4)分,术后第1、3、6个月以及末次随访时采用VAS评分评价临床效果。结果：12例患者手术出血量500～2050ml,平均850ml。手术时间3.5～5.5小时,平均4.5小时。无术中神经损伤病例。脑脊液漏3例,经保守治疗后自愈。切口浅表感染2例,经换药后愈合。肺部感染1例。无深部感染、下肢血栓等并发症。术后12例患者均获得随访,随访时间9～40月,平均随访时间28.6月。临床症状均有明显改善,下肢运动功能不同程度的恢复,ASIA分级:2例C级恢复至D级,1例C级恢复不明显,1例D级恢复至E级。1例患者术后10个月内死于原发性肝癌。随访期间1例患者局部肿瘤复发。术后第1、3、6个月以及末次随访时VAS评分分别为：(2.7±0.6)、(2.5±0.4)、(2.6±0.5)、(2.5±0.5),与术前比较,均获得显著改善(P<0.05)。结论：开放微波消融联合椎体成形、钉棒系统内固定治疗胸腰椎转移瘤效果肯定,术中出血量较少、手术时间较短、术后疼痛缓解明显、肿瘤复发率低。 |
| 【关键词】微波消融 开放椎体成形 胸腰椎转移瘤 |
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| The clinical study of open decompression microwave ablation combined with open vertebroplasty and pedicle screw rod system in the treatment of spine metastases |
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| ABSTRACT Objectives：To evaluate the preliminary clinical effective of open decompression, microwave ablation combined with open vertebroplasty and pedicle screw rod system in the treatment of spine metastases.Methods：Between Jan 2014 and Jan 2016, 12 patients with spine metastases were treated with open decompression microwave ablation combined with open vertebroplasty and pedicle screw rod system. 6 patients were male and the others were female, aged from 30 to 75years (mean, 55.6 years). 5 cases metastasized from lung cancer,2 from breast cancer,2 from thyroid cancer,2 from renal cancer and 1 from liver cancer.7 cases were thoracic metastases,5 cases were Lumbar metastases. Tomita score were mainly concentrated in 3 ~ 6 points.According to ASIA neurologic grading system,3 were grade C,1 was grad D,8 were grad E.Pain was evaluated by visual analogue scale(VAS) score.The clinical effect of surgery was evaluated by VAS score at the time of 1st month after surgery,3rd month after surgery,6th month after surgery and the time of last follow-up. Results：All patients were successfully operated and the amount of blood lose in surgery was 500~2050ml(mean, 850ml), operation time was3.5~5.5 hours (mean,4.5 hours). There was no nerve root injury during surgery. Dural tear in 3 cases, all recoverd by conservative treatment.Wond infection in two cases,were cured by dressing change.And lung infection in 1 case.There was no serious complication such as deep infection and deep vein thrombosis.12 patients were followed up 9~40 months (median, 28.6 months). All patients obtained good pain relief after surgery.Functional recovry of lower limbs in different degrees,according to ASIA,2 cases of grade C improved to grade B,1 case of grade C remain the same,1 case of grade D improved to grade E.1 patient died of primary liver cancer in 10 monthes after surgery.During the follow-up 1 patient got local cancer recurrence.The postoperative VAS scores of pain at 1 month, 3 months, 6 months, and last follow-up were 2.7±0.6,2.5±0.4,2.6±0.5,and 2.5±0.5 respectively, showing significant differences when compared with preoperative VAS scores (P<0.05). Conclusion：Open decompression, microwave ablation combined with open vertebroplasty and pedicle screw rod system can achieve satisfactory clinical results in the treatment of spine metastases.It has the advantage of less blood loose in surgery,less time cost during surgery,excellent pain relief after surgery and low rate of cancer recurrence |
| KEY WORDS microwave ablation spine metastases open vertebroplasty |
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