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目的分析影响脊柱转移性肿瘤一期后路单切口360度减压椎体切除重建内固定术的手术时间和出血量的因素。方法分析2007—2012年48例脊柱转移性肿瘤患者在接受同一组高年资医生做的后路经椎弓根途径行一期后路单切口360度减压椎体切除重建内固定术的12个可能影响因素:手术顺序、性别、年龄、肿瘤类型、术前神经功能的Frankel分级、肿瘤血管丰度、切除椎体的部位、椎体切除的节段数、内固定节段数、椎弓根累计数、TPA人路的途径、钛网的类型等。观察其对手术时间和手术估计出血量的影响。结果随着手术顺序和患者年龄的增加,手术时间明显减少(P<0.01)。≤4节段的内固定明显比>4节段内固定的手术时间少,2、4和6节段手术时间分别为(2.85±0.22)、(4.11±1.25)和(6.42±1.25)h(P<0.01)。而2节段和4节段固定的手术时间差异无统计学意义(P>0.05)。血供丰富的肿瘤组出血量[(4171.42±992.83)ml]明显较非血供丰富组术中出血量要大[(1367.07±706.72)ml,P<0.01],差异有统计学意义。应用可撑开钛网[(1581.25±1409.97)ml]进行前柱重建比非可撑开钛网[(1970.83±1776.04)ml]的出血量要少,差异有统计学意义(P<0.05)。未发现其他因素对手术时间和出血量的影响。结论影响手术时间的因素包括手术顺序、患者年龄、内固定节段数,结果支持≤4节段的内固定。影响出血量的因素包括肿瘤血管丰度和钛网类型,应推荐应用可撑开钛网进行前柱重建。
Objective To analyze the factors influencing the operation time and bleeding amount of 360 ° decompressive vertebral excision and reconstruction and internal fixation of single stage posterior spinal metastasis tumor. Methods Forty-eight patients with metastatic spine from 2007 to 2012 who underwent the same procedure with pediatric pediatric posterior pedicle instrumentation underwent a single-stage 360-degree decompressive vertebral body reconstruction and internal fixation One possible influencing factor: operative order, sex, age, tumor type, Frankel grade of preoperative neurological function, tumor vascular abundance, site of resected vertebral body, number of vertebrectomy segments, internal fixation segments, total pedicle Number, TPA way, the type of titanium mesh and so on. Observe the impact of surgery on the estimated operative time and bleeding volume. Results The operation time and patients’ age increased significantly (P <0.01). The internal fixation of ≤4 segments was significantly less than the operative fixation of> 4 segments, and the durations of 2, 4 and 6 segments were (2.85 ± 0.22), (4.11 ± 1.25) and (6.42 ± 1.25) h P <0.01). However, there was no significant difference in the operation time between two segments and four segments (P> 0.05). The blood loss in the blood-rich tumor group (4171.42 ± 992.83) ml was significantly higher than that in the non-blood-rich group [(1367.07 ± 706.72) ml, P <0.01], and the difference was statistically significant. The amount of bleeding in the unstirred titanium mesh [(1970.83 ± 1776.04) ml] was less than that in the open titanium mesh [(1581.25 ± 1409.97) ml], with significant difference (P <0.05). No other factors were found to affect the operation time and bleeding volume. Conclusion The factors affecting the operation time include the operation sequence, patient’s age, the number of internal fixation segments, and the results support the internal fixation of ≤4 segments. Factors affecting bleeding volume include tumor vascular abundance and titanium mesh type, should be recommended to open the titanium mesh can be used to rebuild the anterior column.