CAJ | 학술논문

　　背景：脊柱骨转移瘤好发于胸腰段，由于解剖部位复杂给内固定物置入治疗带来难度。目的：评价胸腰段单发椎体转移瘤患者人工椎体或内固定物置入治疗后的稳定性。方法：选取2006年1月至2009年1月河北医科大学第四医院骨科收治的胸腰段单发椎体转移瘤患者16例，男9例，女7例；年龄40-74岁，平均年龄52岁。治疗前Frankel分级：A级2例，B级3例，C级3例， D级5例，E级3例。治疗前所有患者均给予X射线平片检查、核素全身骨扫描检查、CT检查、磁共振检查，以评估患者椎体情况。经胸前入路人工椎体或内固定物置入治疗T11椎体转移瘤，经胸膜外和腹膜外间隙入路人工椎体或内固定物置入治疗T12-L2椎体转移瘤。结果与结论：16例患者均获得随访，随访时间4-32个月，治疗后平均生存时间大于12个月。治疗后Frankel分级：C级3例，D级5例，E级8例。目测类比评分其平均分由治疗前的(6.22±1.31)分降至治疗后的(3.25±0.94)分，两组比较差异有显著性意义(P<0.05)。通过人工椎体或内固定物置入可以恢复脊柱转移瘤患者的椎体稳定性，以达到改善患者症状、提高生活质量的效果。
　　배경：척주골전이류호발우흉요단，유우해부부위복잡급내고정물치입치료대래난도。목적：평개흉요단단발추체전이류환자인공추체혹내고정물치입치료후적은정성。방법：선취2006년1월지2009년1월하북의과대학제사의원골과수치적흉요단단발추체전이류환자16례，남9례，녀7례；년령40-74세，평균년령52세。치료전Frankel분급：A급2례，B급3례，C급3례， D급5례，E급3례。치료전소유환자균급여X사선평편검사、핵소전신골소묘검사、CT검사、자공진검사，이평고환자추체정황。경흉전입로인공추체혹내고정물치입치료T11추체전이류，경흉막외화복막외간극입로인공추체혹내고정물치입치료T12-L2추체전이류。결과여결론：16례환자균획득수방，수방시간4-32개월，치료후평균생존시간대우12개월。치료후Frankel분급：C급3례，D급5례，E급8례。목측류비평분기평균분유치료전적(6.22±1.31)분강지치료후적(3.25±0.94)분，량조비교차이유현저성의의(P<0.05)。통과인공추체혹내고정물치입가이회복척주전이류환자적추체은정성，이체도개선환자증상、제고생활질량적효과。
BACKGROUND:Vertebral metastatic tumor often occurs in the thoracolumbar segment, and it is difficult for internal fixation due to the complex anatomical position. OBJECTIVE:To evaluate the stability of lumbar vertebra in the patients with single thoracolumbar vertebral metastases after treated with artificial vertebral placement and internal fixation. METHODS:Sixteen patients (9 male and 7 female) with single thoracolumbar vertebral metastases treated in the Department of Orthopedics, the Fourth Hospital of Hebei Medical University from January 2006 to January 2009 were selected, and the age ranged 40-74 years, averaged 52 years. Before treatment, al the patients were evaluated according to Frankel classification:A grade in two cases, B grade in three cases, C grade in three cases, D grade in five cases, and E grade in three cases. And the vertebral state of patients was detected with X-ray plain film examination, systemic radionuclide bone scanning, CT and MRI. The T11 vertebral metastases were treated with chest approach artificial vertebral placement and internal fixation, and T12-L2 vertebral metastases were treated with artificial vertebral placement and internal fixation via extrapleural and extraperitoneal space approach. RESULTS AND CONCLUSION:Al the 16 patients were fol owed up for 4-32 months, and the average survival time after treatment was 12 months. After treatment, Frankel classification was C grade in three cases, D grade in five cases and E grade in eight cases. The visual analog scale score was decreased from (6.22±1.31) before treatment to (3.25±0.94) after treatment, and there was significant difference between two groups (P<0.05). The artificial vertebral placement and internal fixation can restore the stability of lumbar vertebra in the patients with spinal metastases, and thus improving the symptoms and quality of life.