后路一期全脊椎切除治疗单发转移瘤性硬膜外脊髓压迫症的疗效分析

Efficacy of posterior en bloc spondylectomy for metastatic epidural spinal cord compression

中文关键词:  全脊椎切除术  转移瘤性硬膜外脊髓压迫症  肿瘤转移  治疗结果

英文关键词:Total en bloc spondylectomy  Metastatic epidural spinal cord compression  Neoplasm metastasis  Treatment outcome

中文摘要:

  【摘要】 目的：探讨后路一期全脊椎切除术治疗单发转移瘤性硬膜外脊髓压迫症（MESCC）的疗效及患者生存质量。方法：利用改良一期后路全脊椎整块切除术对2008年12月～2011年6月间收治的9例单发MESCC患者进行手术治疗，先导入线锯由前向后切割病椎上位椎间盘至椎间隙后1/3处，再用“L”形骨刀经两侧由后向前凿至与线锯切割水平处会合，进而完成整个椎间盘的截断，同法完成病椎下位椎间盘的离断。予椎弓根临时棒固定后旋转取出瘤椎。取相邻健康棘突制成骨粒填入钛网植骨，置入钛网后椎弓根钉棒内固定适度加压固定。统计手术并发症，应用VAS评价患者术前、术后疼痛情况，应用ASIA标准评价患者术前、术后运动功能评分，随访记录患者生存时间。结果：病椎均完整切除，手术时间7~10h，平均7.4h，术中出血1300~3200ml，平均2240ml。患者疼痛明显改善，VAS评分由术前8.1±1.2分下降至术后2周3.0±1.7分，改善率为62.8%（P<0.05）；9例脊髓压迫症的患者中1例ASIA分级无变化，8例明显改善，ASIA运动功能评分由术前74.0±15.0分恢复至术后3个月时的91.9±12.9分。术后生存时间平均19.3±5.2个月（9~26个月）。结论：对于单发转移瘤性硬膜外脊髓压迫症的患者，全脊椎切除术可安全有效地进行脊髓环形减压，缓解疼痛，改善神经功能。

英文摘要:

  【Abstract】 Objectives: To investigate the efficacy and prognosis of posterior en bloc spondylectomy(PES) for metastastic epidural spinal cord compression(MESCC).　Methods: 9 cases suffering from MESCC from December 2008 to June 2011 underwent modified PES, which was defined as removing about 1/3 middle-posterior vertebra by using T-saw first, and then the L shape chisel was used to excise the disc from posterior to anterior under direct vision, finally the truncation of the entire disc was cmpleted. The adjacent disc was performed the same procedure. After temporary fixation, the tumor vertebra was released and ressected. Auto bone graft and titanium mesh implantation was performed, after that, posterior instrumentation was added. VAS score, ASIA motor score, recovery of neurological function and complications were reviewed.　　Results: The tumor vertebrae were resected completely, the operation time was 7-10h(average, 7.4h), and the blood loss was 1300-3200ml(average, 2240ml). 9 cases showed significant pain relief， VAS score decreased from 8.1±1.2 points of pre-operation to 3.0±1.7 points of 2 weeks post-operation with the improvement rate of 62.8%. 1 case had no ASIA grade improvement, and 8 cases had significant improvement, with ASIA motor function score improving from 74.0±15.0 points of pre-operation to 91.9±12.9 points of 3 months post-operation. The average survival time was 19.3±5.2 months (range, 9-26 months).　Conclusions: For MESCC, PES can achieve decompression effectively and circularly,which is indicated for pain relief and neurofunction improvement.