论文部分内容阅读
随着肿瘤患者生存期延长,脊柱转移瘤的发病率也越来越高。从解剖部位来看,硬膜外转移瘤发病率远远大于硬膜内转移瘤,前者常常导致脊柱机械稳定性的破坏,大大增加了病理性骨折的风险。此外脊柱转移瘤外科手术不断开展,在肿瘤切除、椎管减压的同时也带来了术后椎体不稳等问题。脊柱的不稳意味着在正常载荷下易出现异常活动和位移。脊柱不稳目前尚无明确的定义,作者认为这一概念应主要包括以下两方面的内容,生物力学方面:创伤、感染、肿瘤、退行性变等多种原因导致的脊柱运动节段的刚度下降、活动度增加,相同负荷下较正常椎体发生更大的位移;临床表现上,不稳脊柱在正常和(或)过度活动时出现疼痛,存在病理性骨折的风险,可能导致脊髓及神经根的压迫损伤。如果可以早期识别脊柱不稳,预测病理性骨折风险,即时采取固定术,会大大改善脊柱转移瘤患者的生活质量,延长生存期。因此,医生需要对脊柱不稳和将要发生的病理性骨折有着很好的预见性。本文主要对脊柱转移瘤椎体不稳相关研究进行综述。
With the extension of survival of cancer patients, the incidence of spinal metastases is also getting higher and higher. From the anatomical point of view, the incidence of epidural metastases is far greater than the intradural metastases, the former often leads to the destruction of the mechanical stability of the spine, which greatly increased the risk of pathological fractures. In addition, spinal metastases continue to carry out surgery, tumor resection, spinal decompression also brought postoperative vertebral instability and other issues. Spine instability means that under normal load prone to abnormal activity and displacement. There is no clear definition of spine instability. The author believes that this concept should mainly include the following two aspects, biomechanics: trauma, infection, cancer, degenerative changes and other causes of spinal motion segment stiffness decreased , Increased mobility, greater displacement under normal load than normal vertebral body; clinical manifestations, unstable spine in the normal and (or) excessive activity of the pain, there is the risk of pathological fracture may lead to spinal cord and nerve root Oppression damage. If you can identify the instability of the spine early to predict the risk of pathological fractures, immediate fixation, will greatly improve the quality of life of patients with spinal metastases and prolong survival. Therefore, doctors need to have good predictability of the instability of the spine and the pathological fractures that will occur. This article mainly summarizes the related studies of vertebral instability in spinal metastases.