中国骨与关节杂志
中國骨與關節雜誌
중국골여관절잡지
Chinese Journal of Bone and Joint
2014年
5期
346-350
,共5页
陈秉耀%韦兴%史亚民%李南%马云青%宋光泽%张增亮%王硕%侯树勋
陳秉耀%韋興%史亞民%李南%馬雲青%宋光澤%張增亮%王碩%侯樹勛
진병요%위흥%사아민%리남%마운청%송광택%장증량%왕석%후수훈
导管消融术%内固定器%减压术,外科%脊椎肿瘤%肿瘤转移
導管消融術%內固定器%減壓術,外科%脊椎腫瘤%腫瘤轉移
도관소융술%내고정기%감압술,외과%척추종류%종류전이
Catheter ablation%Internal ifxators%Decompression,surgical%Spinal neoplasms%Neoplasm metastasis
目的:评价开放微波消融技术和减压内固定技术结合治疗椎体转移瘤的初步临床结果。方法2006年3月至2010年12月,本科收治的椎体转移瘤76例,男48例、女28例,年龄34~80(平均57.4)岁,累及单一椎体51例、2个椎体受累22例、3个椎体受累3例。累及胸椎44例、腰椎16例、颈椎6例、骶椎2例、颈胸段和胸腰段各4例。神经功能障碍55例,其中6例表现为脊髓完全损伤。Tomita分型中,IV~VI型占88.2%。Tomita预后评分主要集中在3~6分。采用开放微波消融和减压内固定结合的方法治疗。在行椎板减压后,经椎弓根置入微波刀头进行消融,通过盐水灌注维持椎管内温度以保护脊髓,辅以短节段椎弓根系统内固定。结果76例均随访2~57个月,中位随访时间24个月。平均手术时间120min,术中平均出血457ml。术后疼痛缓解明显,疼痛VAS评分术前平均6.4,术后1个月平均2.2,与术前比较明显下降,差异有统计学意义(P<0.05)。存活54例,其余22例在术后2~33(平均9.9)个月死亡,总生存率71%。术前存在神经功能障碍的55例中,除6例脊髓完全损伤者外,其余均恢复行走能力。复发9例,其中胸椎6例,腰椎2例,颈椎及骶椎各1例,复发率12%,复发时间为术后2~18(平均9.1)个月。神经并发症3例;伤口延迟愈合6例;继发感染1例,经清创手术后愈合;脑脊液漏9例、下肢深静脉血栓3例、肺部感染3例,均经保守治疗治愈。结论开放式微波消融结合减压内固定手术创伤相对较小、疼痛缓解理想、患者术后功能康复理想、局部控制率相对较高,是治疗椎体转移瘤一种可行的手段。
目的:評價開放微波消融技術和減壓內固定技術結閤治療椎體轉移瘤的初步臨床結果。方法2006年3月至2010年12月,本科收治的椎體轉移瘤76例,男48例、女28例,年齡34~80(平均57.4)歲,纍及單一椎體51例、2箇椎體受纍22例、3箇椎體受纍3例。纍及胸椎44例、腰椎16例、頸椎6例、骶椎2例、頸胸段和胸腰段各4例。神經功能障礙55例,其中6例錶現為脊髓完全損傷。Tomita分型中,IV~VI型佔88.2%。Tomita預後評分主要集中在3~6分。採用開放微波消融和減壓內固定結閤的方法治療。在行椎闆減壓後,經椎弓根置入微波刀頭進行消融,通過鹽水灌註維持椎管內溫度以保護脊髓,輔以短節段椎弓根繫統內固定。結果76例均隨訪2~57箇月,中位隨訪時間24箇月。平均手術時間120min,術中平均齣血457ml。術後疼痛緩解明顯,疼痛VAS評分術前平均6.4,術後1箇月平均2.2,與術前比較明顯下降,差異有統計學意義(P<0.05)。存活54例,其餘22例在術後2~33(平均9.9)箇月死亡,總生存率71%。術前存在神經功能障礙的55例中,除6例脊髓完全損傷者外,其餘均恢複行走能力。複髮9例,其中胸椎6例,腰椎2例,頸椎及骶椎各1例,複髮率12%,複髮時間為術後2~18(平均9.1)箇月。神經併髮癥3例;傷口延遲愈閤6例;繼髮感染1例,經清創手術後愈閤;腦脊液漏9例、下肢深靜脈血栓3例、肺部感染3例,均經保守治療治愈。結論開放式微波消融結閤減壓內固定手術創傷相對較小、疼痛緩解理想、患者術後功能康複理想、跼部控製率相對較高,是治療椎體轉移瘤一種可行的手段。
목적:평개개방미파소융기술화감압내고정기술결합치료추체전이류적초보림상결과。방법2006년3월지2010년12월,본과수치적추체전이류76례,남48례、녀28례,년령34~80(평균57.4)세,루급단일추체51례、2개추체수루22례、3개추체수루3례。루급흉추44례、요추16례、경추6례、저추2례、경흉단화흉요단각4례。신경공능장애55례,기중6례표현위척수완전손상。Tomita분형중,IV~VI형점88.2%。Tomita예후평분주요집중재3~6분。채용개방미파소융화감압내고정결합적방법치료。재행추판감압후,경추궁근치입미파도두진행소융,통과염수관주유지추관내온도이보호척수,보이단절단추궁근계통내고정。결과76례균수방2~57개월,중위수방시간24개월。평균수술시간120min,술중평균출혈457ml。술후동통완해명현,동통VAS평분술전평균6.4,술후1개월평균2.2,여술전비교명현하강,차이유통계학의의(P<0.05)。존활54례,기여22례재술후2~33(평균9.9)개월사망,총생존솔71%。술전존재신경공능장애적55례중,제6례척수완전손상자외,기여균회복행주능력。복발9례,기중흉추6례,요추2례,경추급저추각1례,복발솔12%,복발시간위술후2~18(평균9.1)개월。신경병발증3례;상구연지유합6례;계발감염1례,경청창수술후유합;뇌척액루9례、하지심정맥혈전3례、폐부감염3례,균경보수치료치유。결론개방식미파소융결합감압내고정수술창상상대교소、동통완해이상、환자술후공능강복이상、국부공제솔상대교고,시치료추체전이류일충가행적수단。
Objective To evaluate the clinical outcomes of open microwave ablation combined with decompression and internal ifxation in the treatment of vertebral metastases. Methods From March 2006 to December 2010, a total of 76 patients with vertebral metastases were adopted, including 48 males and 28 females. Their average age was 57.4 years old ( range;34-80 years ). One single vertebral body was involved in 51 cases, 2 vertebral bodies in 22 cases and 3 vertebral bodies in 3 cases. Lesions were found in the thoracic vertebra ( n=44 ), the lumbar vertebra ( n=16 ), the cervical vertebra ( n=6 ), the sacral vertebra ( n=2 ), the cervicothoracic segment ( n=4 ) and the thoracolumbar segment ( n=4 ). Among the 55 patients with neurological deficits, 6 patients had complete spinal cord injuries ( SCI ). According to the Tomita classiifcation system, 88.2%of the patients belonged to type IV-VI. The Tomita prognostic scores were 3-6 points in most patients. Patients underwent the treatment of open microwave ablation combined with decompression and internal fixation. Following laminectomy, microwave antennas were inserted into the vertebra via the pedicles to induce ablation. During this process, the spinal canal was cooled with saline to protect the spinal cord. Short-segment pedicle ifxation was used as an assistance. Results All the patients were followed up for 2-57 months, and the median follow-up time was 24 months. The mean operation duration was 120 min, and the intraoperative blood loss was 457 ml on average. Pain was obviously relieved after the operation. The mean Visual Analogue Score ( VAS ) was 6.4 points before the operation, which was decreased to 2.2 points at 1 month after the operation. There were statistically signiifcant differences between them ( P<0.05 ). The total survival rate was 71%, with 54 patients alive and 22 patients dead at 9.9 month after the operation on average ( range;2-33 months ). Among the 55 patients with neurological deifcits before the operation, 49 patients gained walking ability and the 6 patients with complete SCI did not. Recurrence occurred to 9 cases, with 6 cases in the thoracic vertebra, 2 cases in the lumbar vertebra, 1 case in the cervical vertebra and 1 case in the sacral vertebra. The recurrence rate was 12%, and the mean recurrence time was 9.1 months ( range;2-18 months ). Neurological complications were found in 3 cases, and delayed healing of wounds in 6 cases. One patient with secondary infection recovered after debridement. Conservative treatment was performed on 9 patients with cerebrospinal lfuid leakage, 3 patients with lower limb deep venous thrombosis and 3 patients with pulmonary infection, who all recovered. Conclusions Open microwave ablation combined with decompression and internal ifxation is a potentially promising technique in the treatment of vertebral metastases, with the advantages of minimal trauma, well relieved pain, good postoperative functional recovery and higher local control rate.