Xu Hui, Xiao Song-Hua, Liu Zheng-Sheng, Wang Zheng, Zhang Xue-Song, Lu Niag, Zhao Yong-Fei, Wang Yan
Zhongguo Gu Shang. 2014 Jan;27(1):25-8.
To evaluate surgical strategy and clinical outcomes for the treatment of thoracolumbar metastatic tumor.
From January 2009 to December 2010,42 patients with thoracolumbar metastatic tumor were treated surgically. Among the patients, 30 patients were male, and 12 patients were female, ranging in age from 28 to 76 years old, with an average age of 56.8 years old. Twenty-five patients had metastatic tumor in thoracic vertebraes, and 17 patients had metastatic tumor in lumbar vertebraes. Thirty-four patients had metastatic tumor in 1 segment, 6 patients had metastatic tumor in 2 segments and 2 patients had metastatic tumor in 3 segments. Two patients had no symptoms and 40 patients had back or leg pain. Eighteen patients had neurologic deficits, and 5 patients had injuries of A degree, 3 patients had injuries of B degree, 4 patients had injuries of C degree, 6 patients had injuries of D degree according to ASIA grading system. The operation goal was made according to Tomita evaluation. The surgical procedures included pallative decompression, tumor curettage and total vertebrectomy, which were decided based on Tomita classification. The pain, spinal cord function,part control of tumor,survival rate and conditions of internal fixation were evaluated at 1 week, 3 months, 6 months, 1 year and 2 years after operation.
One patient died in the operation. Pain relief was obtained in 38 patients after operation. Among 18 patients suffering from spinal cord compromise, 17 patients improved 1 to 4 grades after surgery according to the ASIA grading system. All the patients were followed up and the duration ranged from 24 to 48 months, with a mean time of 34.2 months. Five patients got recurrence. The postoperative survival rates at 3 months, 6 months, 1 year and 2 years were 95.2%, 85.7%, 58.2%, 37.6% respectively.
According to Tomita system, the different surgical treatments can be selected for patients with spinal metastatic tumors, which can relieve pain, improve the neurological status and spine stabilization, maintain local control, improve quality of life.
评估胸腰椎转移性肿瘤的手术策略及临床疗效。
2009年1月至2010年12月，对42例胸腰椎转移性肿瘤患者实施手术治疗。患者中男性30例，女性12例，年龄28～76岁，平均年龄56.8岁。胸椎转移瘤25例，腰椎转移瘤17例。单节段转移瘤34例，双节段转移瘤6例，三节段转移瘤2例。2例无症状，40例有腰背痛或腿痛。18例有神经功能缺损，根据ASIA分级系统，5例为A级损伤，3例为B级损伤，4例为C级损伤，6例为D级损伤。根据Tomita评估制定手术目标。手术方式包括姑息减压、肿瘤刮除和全椎体切除术，根据Tomita分类决定。于术后1周、3个月、6个月、1年及2年评估疼痛、脊髓功能、肿瘤局部控制情况、生存率及内固定情况。
1例患者术中死亡。术后38例患者疼痛缓解。18例脊髓受压患者中，根据ASIA分级系统，术后17例改善1～4级。所有患者均获随访，随访时间24～48个月，平均34.2个月。5例复发。术后3个月、6个月、1年及2年生存率分别为95.2%、85.7%、58.2%、37.6%。
根据Tomita系统，可对脊柱转移瘤患者选择不同的手术治疗方式，能缓解疼痛、改善神经功能及脊柱稳定性、维持局部控制、提高生活质量。
