后路全椎体切除骨水泥灌注在上胸椎转移瘤中的应用

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摘要目的探讨一期后路全椎体切除椎弓根螺钉固定联合骨水泥灌注，在上胸椎(T_1～4)转移性肿瘤手术治疗中的应用价值。方法 2014年3月至2016年6月，收治上胸椎转移肿瘤11例，其中男6例，女5例；年龄41～78岁，平均(61.6±18.3)岁。T₁ 4例，T₂ 3例，T₃ 3例，T₄ 1例，均为转移性肿瘤。来源于乳腺癌4例，肺癌3例，直肠癌1例，甲状腺癌1例，食管癌1例，前列腺癌1例。视觉模拟评分(visual analogue scale，VAS)评分3～5分(良)2例，6～8分(可)3例，8～10分(差)6例，平均7.7分。均采用一期后路全椎体切除椎弓根螺钉固定联合骨水泥灌注。结果本组手术时间120～210 min，平均(155.0±37.2)min；出血量为800～2 000 mL，平均(1 100±324)mL。无血气胸、硬膜损伤、神经症状加重等并发症的发生，未出现任何与内固定器械和骨水泥灌注有关的神经、血管损伤。本组11例均获得随访，随访时间6～33个月，平均(16.3±13.7)个月。近期疗效较满意，VAS评分3～5分(良)9例，6～8分(可)2例，平均4.3分，疼痛缓解明显。随访期间3例分别于术后16.2、9.4、11.9个月死亡；其余8例继续生存，术后至末次随访平均17.7个月，其中6例无病生存。结论上胸椎转移肿瘤一期后路全椎体切除椎弓根螺钉固定联合骨水泥灌注重建稳定性安全、有效，提高了患者的生存质量。

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	薛文 1
	管晓鹂 2
	刘林 1

关键词 ：转移性肿瘤, 上胸椎, 骨水泥, 后路, 手术治疗

Abstract：Objective To investigate the clinical effects of one-stage posterior approach total vertebral resection combined with bone cement infuse and screw fixation for upper thoracic metastatic tumors.Methods A retrospective review was conducted on 11 consecutive patients (from March 2014 to June 2016)，with an average age of (61.6±18.3) years old.A total of 251 vertebrae were involved.All of them were metastatic tumors，including breast cancer (4 cases)，lung cancer (3 cases)，rectal cancer (1 case)，thyroid carcinoma (1 case)，esophageal cancer (1 case)，and prostate cancer (1 case).VAS scores from 3 to 5 points (good)，covering 2 of 11 cases；6 to 8 points (general) in 3 cases；8 to 10 points (poor) in 6 cases，with an average of 7.7 points.All the patients were treated with one-stage posterior total vertebral resection and pedicle screw fixation combined with bone cement perfusion.Results The average surgery time was (155±37.2)min (120～210 min)；the intraoperative blood loss was (1 100±324)mL (800～2000 mL).There were no pneumothorax，epidural damage，nervous symptoms or other operation-related complications，nor any internal fixation and bone cement perfusion associated with blood vessels or nervous injury perioperative.The average follow-up time of patients was (16.3±13.7)months (6～33 months).The mean preoperative VAS score was 7.7 points，which decreased to 4.3 points postoperative.3 patients died of original cancer，while the other 8 patients remained alive.Conclusion The operation method of one-stage posterior approach total vertebral resection combined with bone cement infuse and screw fixation for upper thoracic metastatic tumors is safe，minimal invasive and reliable，which can obviate anterior surgery injury.

Key words： metastatic tumor upper thoracic bone cement posterior approach surgical treatment

作者简介: 薛文(1976－ )，男，主任医师，甘肃省人民医院骨2科，730000。

引用本文:

薛文 1，管晓鹂 2，刘林 1. 后路全椎体切除骨水泥灌注在上胸椎转移瘤中的应用[J]. 实用骨科杂志, 2018, 24(1): 1-4.
Xue Wen，Guan Xiaoli，Liu Lin. Clinical Observation on the Treatment of Upper Thoracic Metastatic Tumors by One stage Posterior Approach Total Vertebral Resection Combined with Bone Cement Infuse and Screw Fixation. sygkzz, 2018, 24(1): 1-4.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2018/V24/I1/1

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