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目的:探讨脊柱转移瘤患者手术治疗的适应证与疗效。方法:对1998年7月至2003年7月5年间收治的167例脊柱转移瘤患者的临床资料进行回顾性分析。胸椎转移99例,腰椎转移53例,颈椎转移15例。男性96例,女性71例。出现神经系统受损者112例,其中Frankel分级A级17例,B级11例,C级22例,D级62例。患者均有不同程度的疼痛,手术根据肿瘤破坏脊椎的部位行前路椎体切除、钢板内固定术或后路病变椎板切除、肿瘤切除、椎管减压、经椎弓根内固定术。结果:167例患者中,155例(92.8%)术后疼痛得到缓解。112例有神经功能损害的患者中,67例(59.8%)术后Frankel分级有不同程度的改善。随访6～48个月,术后存活1年以上的患者117例,约占患者总数的70%。结论:由于转移瘤所致椎体塌陷或不稳定造成严重的神经损害或机械性不稳脊柱痛疼的患者,手术治疗可改善其神经功能,增加脊椎稳定性,提高生存质量。
Objective: To investigate the indications and curative effect of surgical treatment of patients with spinal metastases. Methods: The clinical data of 167 patients with spinal metastases admitted to our hospital from July 1998 to July 2003 were analyzed retrospectively. 99 cases of thoracic transfer, 53 cases of lumbar metastases, and 15 cases of cervical metastases. 96 males and 71 females. There were 112 cases of nervous system damage, of which Frankel grading A class in 17 cases, B class in 11 cases, C class in 22 cases, D class in 62 cases. All patients had varying degrees of pain. Surgery was performed according to anterior vertebral body excision of the spine undergoing tumor destruction, internal fixation of the plate or posterior laminectomy, tumor resection, decompression of the spinal canal, and pedicle screw fixation. Results: Out of 167 patients, 155 (92.8%) postoperative pains were relieved. Of 112 patients with neurological impairment, 67 (59.8%) had postoperative Frankel grading with varying degrees of improvement. During the follow-up of 6 to 48 months, 117 patients survived for more than one year, accounting for about 70% of the total number of patients. CONCLUSION: Surgery can improve the neurological function, increase the stability of the spine and improve the quality of life in patients with severe nerve damage or mechanical instability due to collapse or instability of the vertebral body due to metastases.