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目的探讨骨水泥椎体重建联合椎弓根螺钉治疗胸腰椎转移瘤患者的临床疗效。方法回顾性分析25例胸腰椎转移瘤患者的临床资料,根据术前Tokuhashi预后评分系统、肿瘤侵犯的节段和范围、有无神经症状,选择不同手术方式治疗。采用VAS疼痛评分和神经功能Frankel分级评价手术疗效。结果 25例患者获得随访7~60(11.3±2.1)个月。患者术后疼痛均减轻,VAS疼痛评分由术前(7.3±2.1)分降至术后(2.5±1.5)分(P<0.05)。16例脊髓功能损害患者的术后神经功能Frankel分级评定:14例分别提高1级或2级,2例术后未得到改善。随访期间未发现有骨水泥下沉、松动、椎体塌陷及成角畸形,CT显示骨水泥在椎体内分布均匀,弥散良好,但7例(9个椎体)存在不同程度的骨水泥渗漏。19例患者随访期间死亡。结论胸腰椎转移瘤患者依据单发或多发转移、有无神经功能损害及全身状况选择不同的手术方法,可明显减轻患者疼痛,改善神经功能,提高患者生存质量。
Objective To investigate the clinical effect of cementless vertebral reconstruction combined with pedicle screw in the treatment of thoracolumbar metastases. Methods The clinical data of 25 patients with thoracolumbar metastasis were retrospectively analyzed. According to the preoperative Tokuhashi prognostic scoring system, the extent and range of tumor invasion, the presence of neurological symptoms and the choice of different surgical methods. VAS pain score and neurological Frankel grading evaluation of surgical efficacy. Results 25 patients were followed up for 7 to 60 (11.3 ± 2.1) months. The postoperative pain was relieved in all patients. VAS pain score decreased from 7.3 ± 2.1 to 2.5 ± 1.5 (P <0.05). The Frankel grading of neurological function in 16 patients with spinal cord injury was improved by one grade or two grade in 14 cases, while two cases were not improved after operation. During the follow-up period, no bone cement subsidence, loosening, collapse of the vertebral body and angular deformity were found. CT showed that the cement was well distributed in the vertebral body and well dispersed. However, there were different degrees of bone cement in 7 cases leak. Nineteen patients died during follow-up. Conclusions Patients with thoracolumbar metastasis can choose different surgical methods according to single or multiple metastases, with or without neurological impairment and general condition, which can significantly reduce pain, improve neurological function and improve the quality of life of patients.