CAJ | 학술논문

目的：探讨腰骶部转移瘤外科治疗的效果。方法2009年9月至2012年12月共有26例腰骶部转移性肿瘤患者接受手术治疗。肺癌转移9例，直肠癌转移3例，乳腺癌转移7例，肝癌转移4例，不明原因转移性肿瘤3例。其中有腰骶部疼痛和/或下肢疼痛者23例，有骶髂关节不稳、活动时疼痛加重者20例，术前15例出现马鞍区感觉减退，排尿困难或便秘，部分下肢活动及感觉障碍。结果2例术后出现脑脊液漏，3例术后切口感染及延期愈合，26例患者中有21例患者术后疼痛明显缓解。疼痛术前数字评分量表评分平均8.1分（4~9分），术后为2.1分（0~4分），与术前比较差异有统计学意义（ P﹤0.05）。随访期间未出现钉棒断裂情况。术前15例有神经功能损害的患者中，12例术后症状改善，3例术后膀胱、直肠功能无改善，总的术后症状缓解率为80％，半数患者能正常从事一般学习和工作。结论依据腰骶椎转移性肿瘤对椎体破坏程度的不同使用不同的后路脊柱-骨盆固定融合术，手术设计更灵活，固定更加牢固，能有效解决脊柱和骨盆的稳定性重建这一治疗中的难点，取得了较满意的临床治疗效果。
목적：탐토요저부전이류외과치료적효과。방법2009년9월지2012년12월공유26례요저부전이성종류환자접수수술치료。폐암전이9례，직장암전이3례，유선암전이7례，간암전이4례，불명원인전이성종류3례。기중유요저부동통화/혹하지동통자23례，유저가관절불은、활동시동통가중자20례，술전15례출현마안구감각감퇴，배뇨곤난혹편비，부분하지활동급감각장애。결과2례술후출현뇌척액루，3례술후절구감염급연기유합，26례환자중유21례환자술후동통명현완해。동통술전수자평분량표평분평균8.1분（4~9분），술후위2.1분（0~4분），여술전비교차이유통계학의의（ P﹤0.05）。수방기간미출현정봉단렬정황。술전15례유신경공능손해적환자중，12례술후증상개선，3례술후방광、직장공능무개선，총적술후증상완해솔위80％，반수환자능정상종사일반학습화공작。결론의거요저추전이성종류대추체파배정도적불동사용불동적후로척주-골분고정융합술，수술설계경령활，고정경가뢰고，능유효해결척주화골분적은정성중건저일치료중적난점，취득료교만의적림상치료효과。
Objective Toinvestigatetheefficacyofsurgicaltreatmentoflumbosacralmetastictumor.Methods Between September 2009 and December 2012,twenty-six patients with metastatic lumbosacral tumors treated in our department were studied retrospectively. There were metastasis of lung cancer in 9 cases;metastasis of rectal cancer 3 cases,breast cancer me-tastasis in 7 cases,liver metastasis,in 4 cases of metastatic tumors of undefined in 3 cases. Twenty-three patients had pain at lumbosacral region and/or lower limbs,of which twenty patients felt pain aggravated while ambulating. Saddle area hypoesthesia occurredin15patientswithdysuriaorconstipation,partoflowerextremityactivityandsensorydysfunction.Results Thelum-bosacral pain were alleviated significantly(21/26),cerebrospinal fluid leakage in 2 cases,wound infection and delayed healing in 3 cases. NRS scores was 7. 4(4~9)before operation and was 2. 4(0~4)after operatio,there was significant difference compared with that before operation(P﹤0. 05). No screw or rod fracture was found in the follow-up period. The neurological function were improved to some degrees(12/15). However bladder and rectum dysfunction and sexual dysfunction were ob-served in 3 patients. The total postoperative symptom relief rate was 80%,half of the patients can be normal in daily learning andworking.Conclusion Thesurgicaltreatmentoflumbosacralmetastasesdependsonthetumortype,locationwithinspine and damage degree of vertebral. Different posterior spinal-pelvic fixation fusion are effective means of achieving stabilization, providing significant pain relief and preserving ambulatory capacity.