论文部分内容阅读
目的:探讨骨水泥在胸腰椎转移瘤后路手术中的应用价值。方法:2004年3月～2008年12月,后方入路手术治疗胸腰椎转移性肿瘤患者26例,原发肿瘤:肺癌9例,乳腺癌7例,肝癌4例,前列腺癌2例,肾癌1例,来源不明3例。病灶累及单节段17例,两节段9例。23例伴不同程度的腰背部疼痛;神经功能按Frankel分级:B级6例,C级7例,D级11例,E级2例。术中采用骨水泥联合椎弓根螺钉重建脊柱稳定性,其中骨水泥填塞15个椎体,骨水泥前方重建9个椎体,骨水泥椎体成形11个椎体,10例合并骨质疏松患者同时采用骨水泥加强椎弓根钉道。结果:术中未发现骨水泥放热效应引起的神经功能受损。24例患者获得完整随访,随访时间3～42个月,平均18.2个月,23例术前有不同程度腰背疼痛者术后疼痛消失6例,缓解14例;术前伴神经功能障碍者17例(77%)获得神经功能改善。随访期间未发现骨水泥下沉、椎节塌陷及向前成角。1例骨水泥填塞术后3个月骨水泥界面出现松动,但未引起神经压迫症状。15例随访期间死亡。结论:在胸腰椎转移性肿瘤后路手术治疗中,根据患者的全身情况、预期寿命、肿瘤类型、转移椎体位置及骨密度,充分利用骨水泥独特的理化特性,进行多种不同方式的应用,可以减小手术创伤,提高生存质量。
Objective: To evaluate the value of bone cement in posterior thoracolumbar metastasis. Methods: From March 2004 to December 2008, 26 patients with thoracolumbar metastasis were treated by posterior approach. The primary tumors were 9 cases of lung cancer, 7 cases of breast cancer, 4 cases of liver cancer, 2 cases of prostate cancer, 2 cases of kidney cancer 1 case, 3 cases of unknown origin. Lesions involving a single segment in 17 cases, two segments in 9 cases. Twenty-three patients had different degrees of lower back pain. The neurological function was classified according to Frankel classification: Grade B in 6 cases, Grade C in 7 cases, Grade D in 11 cases and Grade E in 2 cases. During the operation, bone cement and pedicle screw were used to reconstruct the spinal column. Among them, 15 vertebral bodies were inflated with bone cement, 9 vertebral bodies were reconstructed in front of the bone cement, 11 vertebral bodies were formed in the vertebral body with cement and 10 vertebral bodies in the osteoporosis group At the same time using bone cement to enhance pedicle screw Road. Results: No intraoperative nerve function impairment caused by exothermic effect of bone cement was found. 24 patients were followed up for 3 ~ 42 months with an average of 18.2 months. Twenty-three of the 23 patients with different degrees of back pain before operation had postoperative pain disappeared in 6 cases and 14 cases were relieved. Patients with preoperative neurological deficits Cases (77%) gained neurological improvement. During follow-up, no bone cement subsidence, vertebral collapse and anterior angulation were found. In one case, bone cement interface became loose at 3 months after cementing but did not cause nerve compression symptoms. 15 patients died during follow-up. Conclusions: In the treatment of thoracolumbar metastasis posterior surgery, according to the patient’s general condition, life expectancy, tumor type, the location of vertebral transfer and bone mineral density, make full use of the unique physical and chemical properties of bone cement, a variety of different ways , Can reduce the surgical trauma, improve the quality of life.