经胸椎体切除术治疗脊柱转移瘤.DOCVIP

临床医学论文-经胸椎体切除术治疗脊柱转移瘤 ??????? 作者：常增林 崔新广 刘近举 青光恒 李锋 【关键词】? 肿瘤转移 ??? 摘? 要：［目的］探讨经胸椎体切除术、前路内固定系统重建脊柱稳定治疗胸椎转移瘤的临床效果。［方法］回顾性分析21例胸椎转移瘤患者采用经胸椎体切除、单纯植骨支撑融合或钛网支撑植骨融合、载抗肿瘤药骨水泥应用及前路内固定重建技术的治疗效果。男13例，女8例；年龄32～68岁，平均485岁，主要原发瘤包括肺癌6例，肾癌5例，乳腺癌5例，其它肿瘤5例，最常见的临床表现是背痛20例，下肢无力10例，下肢不全瘫伴感觉及腱反射异常8例，1例全瘫。［结果］所有病例获得完整随访，随访时间6～56个月，平均24个月。15例患者疼痛缓解，10例术前双下肢无力但能行走的患者中，术后完全恢复正常；9例术前不能行走的患者中，术后6例能够行走，3例行走未恢复，但神经功能有明显改善。肿瘤局部复发5例，复发率238％。［结论］经胸椎体切除、前路内固定系统重建术治疗胸椎转移瘤能够明显改善患者的生存质量，恢复或保护患者的运动功能，控制顽固的脊柱疼痛。 　　关键词：脊柱；? 肿瘤转移；? 椎体切除；? 治疗结果 　　Transthoracic vetebrectomy for metastatic spinal tumors 　　Abstract：［Objective］To evaluate the clinical results for patients with metastatic spinal tumors treated by means of anterior vertebral body resection,reconstruction,and stabilization［Method］Twentyone patients with metastatic spinal tumors were treated by means of anterior vertebral body resection,decompression,reconstruction with an adriamycinbone cement packed Ti mesh cage or rib strut graft,and anterior fixation with locking plate and screw construction, all cases were analyzed retrospectivelyThere were 13 males and 8 females with the average age of 485 years old(ranged,32~68 years)The predominant primary tumors included lung cancer in 6 patients,renal cancer in 5,breast cancer in 5,and others in 5The most common presenting symptoms were back pain in 20 patients,incompletely paralysis in 8 patients,complete paralysis in one patients［Result］After surgery,all patients were reviewedThe mean followup period was 24 months(ranged,6~56 months)Pain decreased in 15 of all 20 patientsTen patients who had low limbs weakness but could ambulate preoperatively regained normal strengthIn the 9 patients without ambulatory ability,6 could walk after surgery and 3 were still unable to walk but showed improved motor functionTumor reoccurred in 5 cases［Conclusion］It suggests that transthoracic vertebrectomy and spinal stabilization can improve the quality of daily life considerably in cancer patients with spinal metastasis,i