Bauer H C
Oncology Service, Department of Orthopedics, Karolinska Hospital, Stockholm, Sweden.
J Bone Joint Surg Am. 1997 Apr;79(4):514-22. doi: 10.2106/00004623-199704000-00006.
The neurological function, survival, and rehabilitation of sixty-seven consecutive patients who had been managed operatively for spinal metastases with epidural compression were assessed. The epidural compression was in the thoracic spine in forty-one patients and in the lumbar spine in twenty-six. According to the system of Frankel et al. for the assessment of neurological function, twenty-six patients had a major neurological deficit (grade B or C), thirty-two had a minor deficit (grade D), and nine had no deficit (grade E). None of the patients had an operation to treat a pathological vertebral fracture without epidural compression. The operative treatment included wide decompression through a posterior approach followed by stabilization without bone-grafting. A Cotrel-Dubousset device was used in thirty-two patients; an Olerud posterior fixator, in sixteen; an Isola device, in twelve; and another device, in seven. The most common complication was wound infection (eleven patients). There were no perioperative or immediate postoperative deaths (within fourteen days). The rate of survival was 51 per cent (thirty-four of sixty-seven) at six months and 22 per cent (fifteen of sixty-seven) at twelve months. Over-all, forty-four of the fifty-eight patients who had had a neurological deficit preoperatively had complete or partial neurological recovery within the first two weeks postoperatively. The nine patients who had not had a neurological deficit preoperatively retained normal neurological function postoperatively. Thirty-eight of the forty-four patients who were alive at three months and twenty-nine of the thirty-four who were alive at six months were still able to walk. Thirty-nine of the forty-nine patients who survived more than two months were able to return home for a median of seven months. Fourteen patients had a reoperation on the spine. Six of these patients had recurrent epidural compression at another level of the spine, and five had recurrent compression at the previously treated level. Three patients had a reoperation because of loosening of the implant. The results of this study suggest that neurological function can be maintained or improved by decompression and stabilization through a posterior approach as treatment for spinal metastases.
对67例因硬膜外压迫性脊柱转移瘤接受手术治疗的连续患者的神经功能、生存率及康复情况进行了评估。41例患者的硬膜外压迫位于胸椎，26例位于腰椎。根据Frankel等人的神经功能评估系统，26例患者存在严重神经功能缺损（B级或C级），32例存在轻度缺损（D级），9例无缺损（E级）。所有患者均未接受无硬膜外压迫的病理性椎体骨折的手术治疗。手术治疗包括经后路广泛减压，随后进行无需植骨的稳定手术。32例患者使用了Cotrel-Dubousset器械；16例使用了Olerud后路固定器；12例使用了Isola器械；7例使用了其他器械。最常见的并发症是伤口感染（11例患者）。围手术期或术后即刻（14天内）无死亡病例。6个月时生存率为51%（67例中的34例），12个月时为22%（67例中的15例）。总体而言，58例术前有神经功能缺损的患者中，44例在术后前两周内实现了完全或部分神经功能恢复。9例术前无神经功能缺损的患者术后保留了正常神经功能。3个月时存活的44例患者中有38例、6个月时存活的34例患者中有29例仍能行走。49例存活超过两个月的患者中有39例能够回家，中位时间为7个月。14例患者接受了脊柱再次手术。其中6例患者在脊柱的另一节段出现复发性硬膜外压迫，5例在先前治疗的节段出现复发性压迫。3例患者因植入物松动而接受再次手术。本研究结果表明，通过后路减压和稳定手术治疗脊柱转移瘤可维持或改善神经功能。
