论文部分内容阅读
目的探讨影响脊柱转移瘤硬膜外脊髓压迫症(metastatic epidural spinal cord compression,MESCC)后路减压内固定术的生存预后因素。方法选择2006年1月至2014年12月于解放军307医院骨科接受后路减压内固定术的胸椎MESCC患者72例。收集每例患者性别、年龄、术前美国东部肿瘤协作组(Eastern cooperative oncology group,ECOG)评分、Tokuhashi评分(包括原发肿瘤特点、术前卡氏评分、内脏转移、脊柱外骨转移、脊柱转移瘤数目和Frankel分级)、确诊原发肿瘤和脊柱转移的间隔期、运动障碍出现的时间、受累椎体分布、连续性、病理性骨折、术后行走状态和术后辅助放化疗等数据。运用单因素KaplanMeier法分析各暴露因素组的生存状况并绘制生存曲线,采用多因素Cox比例风险模型筛选胸椎MESCC后路减压内固定术独立的生存预后因素。结果随访结束时,72例中62例死亡,10例仍存活,中位生存期7.45(0.3~91.9)个月。5例(7%)术后1个月内死亡,47例(65%)术后1年内死亡,55例(76%)术后2年内死亡。单因素分析显示,年龄<65岁、术前ECOG评分<2分、Tokuhashi评分>8分、确诊原发肿瘤和脊柱转移的间隔期<24个月、术后可行走和术后辅助放化疗的MESCC患者生存期均明显延长(P<0.05)。多因素Cox比例风险模型分析显示Tokuhashi评分、年龄、和术后行走能力是影响MESCC减压内固定术后生存的独立预后因素。结论 Tokuhashi评分能很好地反映MESCC患者的生存预后情况,同时年龄、术后行走能力也是影响胸椎转移瘤MESCC后路减压内固定术后生存的独立预后因素。
Objective To investigate the prognostic factors of posterior decompression and internal fixation of metastatic epidural spinal cord compression (MESCC). Methods From January 2006 to December 2014, 72 patients with thoracic MESCC undergoing orthopedic decompression and internal fixation in 307 Hospital of Chinese PLA were included. Each patient’s gender, age, preoperative Eastern Cooperative Oncology Group (ECOG) score, Tokuhashi score (including primary tumor characteristics, preoperative Karnaugh’s score, visceral metastases, extra-spine bone metastases, spinal metastases Number and Frankel grading), the interval between the primary tumor and spine metastasis, the time of appearance of dyskinesia, the distribution of vertebral body, continuity, pathological fracture, postoperative walking and postoperative adjuvant chemoradiation were confirmed. The single factor KaplanMeier method was used to analyze the survival status of each exposure group and the survival curves were drawn. The multivariate Cox proportional hazards model was used to screen the independent prognostic factors of thoracic MESCC posterior decompression and internal fixation. Results At the end of follow-up, 62 of 72 patients died and 10 patients survived, with a median survival of 7.45 (0.3-91.9) months. Five patients (7%) died within 1 month after operation, 47 (65%) died within 1 year after operation and 55 (76%) died within 2 years after operation. Univariate analysis showed that the age <65 years, preoperative ECOG score <2 points, Tokuhashi score> 8 points, the diagnosis of primary tumor and spinal metastasis interval <24 months after surgery and postoperative adjuvant chemotherapy and radiotherapy MESCC patients were significantly longer survival (P <0.05). Multivariate Cox proportional hazards model analysis showed that Tokuhashi score, age, and postoperative walking ability were independent prognostic factors that influenced MESCC survival after decompression and internal fixation. Conclusion The Tokuhashi score can well reflect the survival and prognosis of patients with MESCC. Age and postoperative walking ability are also independent prognostic factors for the survival of thoracic metastatic MESCC after posterior decompression and internal fixation.