Onimus M, Papin P, Gangloff S
Service de Chirurgie des Scolioses et Orthopédie Infantile, Hôpital Saint-Jacques, Besançon, France.
Eur Spine J. 1996;5(6):407-11. doi: 10.1007/BF00301969.
The results of surgical treatment of vertebral metastases were evaluated from a retrospective review of a consecutive series of 100 patients, with special reference to anatomoclinical aspects and functional outcome. The primary tumour in most cases was lung, breast, or prostate; it was unknown in 11 cases. Diagnosis of the metastasis occurred 4-86 months after that of the primary tumour (lung metastasis: 4 months; breast metastasis: 86 months; prostatic metastasis: 22 months). Patients complained of vertebral pain in 96 cases and/or radicular pain in 43 cases. Intractable pain was observed in lung metastasis in particular. All patients received analgesics, and 57 received morphinics. Walking was impossible for 50 patients. Thirty-eight patients presented with neurologic deficit; neurologic status varied according to the primary tumour. Treatment included anterior surgery in 58 patients, posterior surgery in 33 patients, and combined surgery in 9 patients. Mean duration of hospitalisation was 12 days. No patient was admitted to the intensive care unit. Mean follow-up was 13.5 months. Eighty-nine patients were dead at follow-up, with an average survival of 10 months. Mean survival time was 7 months for patients with lung metastasis, 12 months for those with breast metastasis and 24 months for those with prostatic metastasis. Ten patients were still alive at follow-up (mean follow-up period 45 months, range 17-72 months). Analgesics were stopped for 62 patients following discharge from hospital. Morphinics had to be continued in seven patients. Thirty-five patients out of 50 (70%) recovered walking capacity. Neurologic status improved in 30 out of 38 patients. Although duration of survival was limited, surgery proved to be beneficial in providing a significant and early improvement in the functional status of more than 80% of patients. A precise evaluation of preoperative pain is necessary. Pain is dependent upon the bony lesion, the primary tumour, and the tumoral topography, which defines the surgical approach.
通过对连续100例患者的回顾性研究，评估了椎体转移瘤的外科治疗结果，特别关注解剖临床方面和功能结局。大多数病例的原发肿瘤为肺癌、乳腺癌或前列腺癌；11例病例的原发肿瘤不明。转移瘤的诊断发生在原发肿瘤诊断后的4 - 86个月（肺转移：4个月；乳腺转移：86个月；前列腺转移：22个月）。96例患者主诉椎体疼痛，43例患者主诉神经根性疼痛。特别是在肺转移患者中观察到顽固性疼痛。所有患者均接受了镇痛药治疗，57例患者接受了吗啡类药物治疗。50例患者无法行走。38例患者出现神经功能缺损；神经功能状态因原发肿瘤而异。治疗包括58例患者接受前路手术，33例患者接受后路手术，9例患者接受联合手术。平均住院时间为12天。无患者入住重症监护病房。平均随访时间为13.5个月。89例患者在随访时死亡，平均生存期为10个月。肺转移患者的平均生存时间为7个月，乳腺转移患者为12个月，前列腺转移患者为24个月。10例患者在随访时仍存活（平均随访期45个月，范围17 - 72个月）。62例患者出院后停用了镇痛药。7例患者必须继续使用吗啡类药物。50例患者中有35例（70%）恢复了行走能力。38例患者中有30例神经功能状态得到改善。尽管生存期有限，但手术被证明有助于显著且早期改善80%以上患者的功能状态。术前疼痛的精确评估是必要的。疼痛取决于骨病变、原发肿瘤和肿瘤的局部解剖结构，后者决定了手术入路。
