全脊椎切除术与次全脊椎切除术治疗脊柱转移瘤的临床疗效分析

Comparative analysis of the clinical outcomes of total spondylectomy and subtotal spondylectomy in treating spinal metastases

中文关键词:  脊柱转移瘤  全脊椎/次全脊椎切除术  手术疗效  生存期

英文关键词:Metastatic carcinoma of spine  Total spondylectomy/subtotal spondylectomy  Postoperative effect  Survival time

中文摘要:

  【摘要】 目的：对比分析全脊椎切除术和次全脊椎切除术治疗脊柱转移瘤的临床疗效。方法：回顾性分析2004年5月~2017年2月在我院接受手术治疗的43例脊柱转移瘤患者的资料，根据手术方式分为两组：全脊椎切除组14例，次全脊椎切除组29例。两组患者性别、年龄、原发肿瘤性质、病灶类型等一般资料差异均无统计学意义（P>0.05）。分别采用KPS（Karnofsky performance scale）评分、视觉模拟量表（visual analogue scale，VAS）评分、Frankel分级对患者术前、术后1个月的功能状态、疼痛程度以及神经功能进行评估。术后随访观察患者生存情况，绘制Kaplan-Meier曲线，使用Log-rank检验进行比较。结果：全脊椎切除组与次全脊椎切除组患者术前VAS评分分别为5.29±1.54分、5.00±1.58分，KPS评分分别为70.71±8.29分、69.31±11.00分，术后1个月VAS评分分别为1.00±1.52分、0.97±1.88分，KPS评分分别为85.00±7.60分、85.17±17.45分，均较术前明显改善，差异有统计学意义（P<0.001），而两组组内无统计学差异（P>0.05）。两组患者术后Frankel分级较术前明显改善，差异有统计学意义（P<0.001），两组组间比较无统计学差异（P>0.05）。术后6例出现局部复发，其中全脊椎切除组1例，次全脊椎切除组5例，两组差异有统计学意义（χ2=6.416，P=0.011）。生存分析结果显示全脊椎切除组患者术后中位生存时间为10.0个月（95%CI：0.29~19.71）；次全脊椎切除组患者术后中位生存时间为11.0个月（95%CI：4.60~17.40），全脊椎切除与次全脊椎切除的两组患者术后半年累积生存率分别为63.6%、63.2%，术后1年生存率分别为45.2%、42.1%，两组间无统计学差异（P>0.05）。结论：全脊椎切除与次全脊椎切除手术均能明显改善脊柱转移瘤患者功能状态、疼痛程度以及神经功能，全脊椎切除有助于减少脊柱转移瘤术后局部复发。

英文摘要:

  【Abstract】 Objectives: To compare and analyze the clinical efficacies of total spinal resection and subtotal spinal resection for the treatment of spinal metastases. Methods: The data of 43 patients with spinal metastases who underwent surgical treatment in our hospital from May 2004 to February 2017 were retrospectively analyzed. According to the surgical method, the patients were divided into two groups: total spinal resection group(14 cases) and subtotal spinal resection group(29 cases). There were no significant differences in gender, age, nature of primary tumor, type of lesion and other general data between the two groups(P>0.05). Karnofsky performance scale(KPS) score, visual analogue scale(VAS) score and Frankel grading were used to evaluate the functional status, pain degree and neurological function of the patients before operation and 1 month after operation. The postoperative survival of patients were followed up, and Kaplan-Meier curves were drawn and compared using the Log-rank test. Results: The preoperative VAS scores were 5.29±1.54 and 5.00±1.58 in total and subtotal spinal resection groups, respectively, and preoperative KPS scores were 70.71±8.29 and 69.31±11.00, respectively. Postoperative 1 month VAS scores were 1.00±1.52 and 0.97±1.88, respectively, and KPS scores were 85.00±7.60 and 85.17±17.45, respectively. The VAS and KPS scores of both groups significantly improved compared with those before operation, and the differences were statistically significant(P<0.001), while there was no statistical difference between the two groups respectively(P>0.05). The Frankel grades of patients of both groups after operation significantly improved compared with those before operation, and the differences were statistically significant(P<0.001), while there was no significant difference between the two groups(P>0.05). Postoperative recurrence occurred in 6 cases, including 1 case in total spinal resection group and 5 cases in subtotal spinal resection group, and the difference was statistically significant(χ2=6.416, P=0.011). Survival analysis showed that the median survival time of patients in the total spinal resection group was 10.0 months(95%CI: 0.29-19.71), which in subtotal spinal resection group was 11.0 months(95%CI: 4.60-17.40). The half a year cumulative survival rates of patients in total spinal resection group and subtotal spinal resection group were 63.6% and 63.2%, respectively, and the 1-year survival rates were 45.2% and 42.1%, respectively, with no statistical differences between groups(P>0.05). Conclusions: Both total and subtotal spinal resection can significantly improve the functional status, pain degree and neurological function of patients with spinal metastases, and total spinal resection is helpful to reduce local recurrence of spinal metastatic tumor after operation.