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目的:报告一种新的脊柱转移性肿瘤的外科治疗策略的疗效,分析该策略的特点和合理性。方法:1996年1月至2006年12月在博洛尼亚Maggiore医院矫形创伤及脊柱外科接受过外科治疗的脊柱转移瘤患者249例,男152例,女97例;年龄15～79岁。按照自行制定的治疗新策略确定治疗方案。根据手术风险的麻醉评估判定手术的可行性:手术风险较低者,可考虑手术治疗;手术风险较高者,不适合外科手术,必须先采取保守治疗。可逆性神经功能损害、病理性骨折、顽固性疼痛以及辅助治疗不敏感者均作为手术指征。手术方式主要分为姑息性手术、刮除手术和整块切除手术。结果:1例术中死亡,共6例术后1月内死亡。91.7%患者疼痛术后明显缓解,88.4%患者术后即时神经功能改善。215例患者平均随访20.4个月,中位生存期为20.9±2.7个月。84.8%的患者得到了良好的局部控制。结论:脊柱转移性肿瘤的外科治疗仍然以改善患者的生存质量为主要目的,而合理的手术治疗能明显地改善患者的生存期和生存质量。术前麻醉风险的评估能较好地保证手术的安全性。依靠量化的评分系统决定脊柱转移瘤的治疗方式存在一定局限性,而个体化、灵活性高的治疗新策略在体现外科治疗的优势的同时强调辅助治疗的重要性,更加科学、合理,所以能够得到较好的疗效。
OBJECTIVE: To report the efficacy of surgical treatment strategies for a new spinal metastatic tumor and analyze the characteristics and rationality of this strategy. METHODS: From January 1996 to December 2006, 249 cases of spinal metastases were treated with orthopedic trauma and spinal surgery at Maggiore Hospital in Bologna. There were 152 males and 97 females aged 15-79 years. According to the self-developed new treatment strategy to determine the treatment program. Anesthesia evaluation based on surgical risk can be used to determine the feasibility of the operation: if the surgical risk is low, surgical treatment may be considered; if the surgical risk is high, it is not suitable for surgery, and conservative treatment must be taken first. Reversible neurological impairment, pathological fractures, intractable pain, and insensitivity to adjuvant therapy are all indications for surgery. Surgical methods are mainly divided into palliative surgery, curettage and en bloc resection. Results: One patient died during the operation. Six patients died within one month after operation. 91.7% of the patients had a significant postoperative pain relief, and 88.4% of patients had improved immediate neurological function after surgery. The mean follow-up period was 20.4 months in 215 patients. The median survival time was 20.9±2.7 months. 84.8% of patients received good local control. Conclusion: Surgical treatment of metastatic spinal tumors is still the main goal to improve the patient’s quality of life, and reasonable surgical treatment can significantly improve the patient’s survival and quality of life. Preoperative anesthetic risk assessment can better ensure the safety of the operation. Relying on a quantified scoring system to determine the treatment of spinal metastases has certain limitations, and the new individualized and flexible treatment strategy embodies the advantages of surgical treatment while emphasizing the importance of adjuvant therapy and is more scientific and reasonable. Get better results.