摘要
[目的]比较肿瘤切除手术与姑息减压手术治疗脊柱转移瘤的临床疗效、并发症和生存时间,以利于更好的适应证选择。[方法]对2002年11月～2010年11月38例行肿瘤切除手术和45例行姑息切除减压手术的脊柱转移瘤患者临床评估并进行随访,平均随访17个月(3～91个月)。采用VAS评分、ECOG评分、Frankel分级对疼痛、功能状况和脊髓功能进行评价。使用Kaplan-Meier法评估生存率。[结果]切除组中位手术时间360 min,姑息组240min(P<0.000 1)。切除组中位出血量3 500 ml,姑息组中位出血量1 200 ml(P<0.000 1)。切除手术和姑息减压手术的VAS评分和ECOG评分在术后1个月均显著降低,两组间疼痛缓解和功能状况改善比较差异无统计学意义(P>0.05)。切除组术前有脊髓功能障碍的患者术后85%Frankel分级得到改善,姑息组为83%。术后切除组18%神经功能再次恶化,中位时间13个月。姑息组31%神经功能再次恶化,中位时间6个月。切除手术组8例发生并发症(21.1%),姑息组9例(20%)。切除组中位生存时间为22个月,姑息组为9个月(P=0.001)。[结论]肿瘤姑息切除减压手术出血少,时间短,风险小,适用于有严重不稳定疼痛、硬膜或神经根压迫的一般情况较差、预期生存期3～6个月的患者,是有价值的治疗方法。对于预期生存期>6个月的患者,尽可能切除肿瘤,达到中长期的局部控制。
[Objective]To observe effect and application of limited internal fixation combined with external fixation and plate fixation for tibial plateau fracture.[Method]From Jan.2007 to Jan.2011,58 patients received surgical treatment,with 38 males and 20 females,aged from 19-54 years,the average age was 42.7 years.According to type Schatzker：17 cases were type Ⅳ,31 cases were type V,10 cases were type Ⅵ.Thirty-one cases were treated with limited internal fixation combined with external fixation,the other（27 cases） were treated with plate fixation.The mean follow-up were 14.1 months（from 6 to17 months）.[Result]For the group of limited internal fixation combined with external fixation,the average operative time was 57.4 min,the blood loss in patients was（161.3±17.0）ml,the average fracture healing time was（12.4） weeks.The wound infection rate was 6%,the needle infection rate was 9%.According to the Lysholm evaluation,the results were excellent in 21 cases（67%）,good in 8 cases（25%）,fair in 2 cases.For the group of plate fixation,the average operative time was 105.4 min,the blood loss in patients was（252.4±28.9）ml,the average fracture healing time was（15.5） weeks,the wound infection rate was 4%.According to the Lysholm evaluation,the results were excellent in 16 cases（60%）,good in 10 cases,（37%）,fair in 1 case.There was significantly different in the operative time,blood loss and bone healing time between the two groups（P〈0.05）.There was no significant difference in wound infection and Lysholm score between groups（P〉0.05）.[Conclusion]Both methods in treating fracture of tibia plateau all have good functional recovery and satisfactory therapeutic effect.Limited internal fixation combined with external fixation treatment is more ideal for open tibial plateau fracture,especially for tibial plateau fractures with severe soft tissue injury and tissue defects.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2012年第6期512-515,共4页
Orthopedic Journal of China
关键词
脊柱
肿瘤转移
外科治疗
spine, neoplasm metastasis, surgery
