CAJ | 학술논문

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入路的途径、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。
목적：분석영향척주전이성종류일기후로단절구360도감압추체절제중건내고정술적수술시간화출혈량적인소。방법분석2007-2012년48례척주전이성종류환자재접수동일조고년자의생주적후로경추궁근도경행일기후로단절구360도감압추체절제중건내고정술적12개가능영향인소：수술순서、성별、년령、종류류형、술전신경공능적Frankel분급、종류혈관봉도、절제추체적부위、추체절제적절단수、내고정절단수、추궁근루계수、TPA입로적도경、태망적류형등。관찰기대수술시간화수술고계출혈량적영향。결과수착수술순서화환자년령적증가，수술시간명현감소（P＜0.01）。≤4절단적내고정명현비＞4절단내고정적수술시간소，2、4화6절단수술시간분별위（2.85±0.22）、（4.11±1.25）화（6.42±1.25）h（P＜0.01），이2절단화4절단고정적수술시간차이무통계학의의（P＞0.05）。혈공봉부적종류조출혈량[（4171.42±992.83）ml]명현교비혈공봉부조술중출혈량요대[（1367.07±706.72）ml，P＜0.01]，차이유통계학의의。응용가탱개태망[（1581.25±1409.97）ml]진행전주중건비비가탱개태망[（1970.83±1776.04）ml]적출혈량요소，차이유통계학의의（P＜0.05）。미발현기타인소대수술시간화출혈량적영향。결론영향수술시간적인소포괄수술순서、환자년령、내고정절단수，결과지지≤4절단적내고정。영향출혈량적인소포괄종류혈관봉도화태망류형，응추천응용가탱개태망진행전주중건。
Objective To investigate influencing factors of operation time and blood loss during single- stage posterior transpedicular approach for circumferential decompression and instrumented stabilization with vertebrectomy reconstruction for spinal metastatic tumor. Methods Data were col ected from 48 consecutive patients undergoing single- stage posterior transpedicular approach for circumferential decompression and instrumented stabilization with vertebrectomy reconstruction for spinal metastatic tumor by one senior surgeon. The influence of 12 related factors on the operation times and/or blood losses dur-ing the surgical procedures were examined. The statistical analysis was performed using SAS version 9.1. Results The order of operation and the age of operation was related to operation time significantly (F=42.45 and 18.41 respectively, both P<0.01). The operation time for 2, 4 and 6- segmental fixation levels were 2.85±0.22, 4.11±1.25 and 6.42±1.25h, respectively;there was sig-nificant difference between 6- segmental fixation and 4 or less- segmental fixation (F=10.36, P<0.01), while there was no signifi-cant difference between 2 and 4 segmental fixation (P>0.05). The blood loss of hypervascular tumors was greater than that of non- hypervascular tumors (4 171.42±992.83ml vs 1 367.07±706.72ml, F=32.03, P<0.01). Expandable cages used for anterior vertebral column reconstruction significantly decreased blood loss compared with un- expandable meshes (1 581.25±1 409.97ml vs 1 970.83±1 776.04ml, F=5.90, P<0.05). Conclusion The order of operation, age of patients and the number of vertebrae fixed would influence the operation time;and the hypervascular tumors and using un- expandable meshes would increased blood loss during the operation.