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目的评价开放微波消融技术和减压内固定技术结合治疗椎体转移瘤的初步临床结果。方法2006年3月至2010年12月,本科收治的椎体转移瘤76例,男48例、女28例,年龄34-80(平均57.4)岁,累及单一椎体51例、2个椎体受累22例、3个椎体受累3例。累及胸椎44例、腰椎16例、颈椎6例、骶椎2例、颈胸段和胸腰段各4例。神经功能障碍55例,其中6例表现为脊髓完全损伤。Tomita分型中,Ⅳ~Ⅵ型占88.2%。Tomita预后评分主要集中在3~6分。采用开放微波消融和减压内固定结合的方法治疗。在行椎板减压后,经椎弓根置入微波刀头进行消融,通过盐水灌注维持椎管内温度以保护脊髓,辅以短节段椎弓根系统内固定。结果 76例均随访2~57个月,中位随访时间24个月。平均手术时间120 min,术中平均出血457ml。术后疼痛缓解明显,疼痛VAS评分术前平均6.4,术后1个月平均2.2,与术前比较明显下降,差异有统计学意义(P<0.05)。存活54例,其余22例在术后2~33(平均9.9)个月死亡,总生存率71%。术前存在神经功能障碍的55例中,除6例脊髓完全损伤者外,其余均恢复行走能力。复发9例,其中胸椎6例,腰椎2例,颈椎及骶椎各1例,复发率12%,复发时间为术后2~18(平均9.1)个月。神经并发症3例;伤口延迟愈合6例;继发感染1例,经清创手术后愈合;脑脊液漏9例、下肢深静脉血栓3例、肺部感染3例,均经保守治疗治愈。结论开放式微波消融结合减压内固定手术创伤相对较小、疼痛缓解理想、患者术后功能康复理想、局部控制率相对较高,是治疗椎体转移瘤一种可行的手段。
Objective To evaluate the preliminary clinical results of open microwave ablation combined with decompression and internal fixation in the treatment of vertebral metastases. Methods From March 2006 to December 2010, 76 cases of vertebral body metastases were admitted to our hospital, including 48 males and 28 females, with an average age of 34-80 (average 57.4 years), involving 51 cases of single vertebrae and 2 vertebrae Involved in 22 cases, 3 vertebral involvement in 3 cases. Involved in the thoracic 44 cases, 16 cases of lumbar, cervical 6 cases, 2 cases of sacral, neck and thoracolumbar in 4 cases. 55 cases of neurological dysfunction, of which 6 cases showed complete spinal cord injury. Tomita type, Ⅳ ~ Ⅵ type accounted for 88.2%. Tomita prognosis score mainly concentrated in 3 to 6 minutes. Open microwave ablation and decompression and internal fixation combined with the treatment. After the decompression in the lamina, the pedicle screw was placed in the microwave ablation, spinal fluid was infused to maintain the spinal canal temperature to protect the spinal cord, supplemented by a short segment of the pedicle system internal fixation. Results 76 cases were followed up for 2 to 57 months, the median follow-up time was 24 months. The average operation time was 120 min, mean intraoperative bleeding 457 ml. The postoperative pain relief was obvious. The pain VAS score was 6.4 preoperatively and 2.2 postoperative one month, which was significantly lower than that before operation (P <0.05). Survival in 54 cases, and the remaining 22 patients died after 2 ~ 33 (average 9.9) months, the overall survival rate was 71%. Preoperative existence of nerve dysfunction in 55 cases, except for 6 cases of spinal cord injury completely, the rest were walking ability. There were 9 cases of recurrence, including 6 cases of thoracic spine, 2 cases of lumbar spine, 1 case of cervical spondylosis and 1 case of sacral spondylosis. The recurrence rate was 12%. The recurrence time was 2 ~ 18 (average 9.1) months after operation. 3 cases of neurological complications, 6 cases of delayed wound healing, 1 case of secondary infection and healing after debridement, 9 cases of cerebrospinal fluid leakage, 3 cases of deep venous thrombosis of lower extremities and 3 cases of pulmonary infection. All of them were cured by conservative treatment. Conclusions Open microwave ablation combined with decompression and internal fixation has the advantages of relatively small surgical trauma, ideal pain relief, good postoperative functional recovery and relatively high local control rate. It is a feasible method for the treatment of vertebral metastases.