摘要
目的探讨全脊椎切除术治疗颈胸段脊柱肿瘤对神经功能的影响,术中脊柱重建策略及疗效。方法回顾性分析自河南大学附属第一医院2014年1月-2016年12月收治的颈胸段脊柱肿瘤患者27例,按照治疗方案的不同分为后路组(n=14)和前后路组(n=13)。后路组给予单一后路全脊椎切除联合稳定性重建,前后路组给予一期前后联合入路全脊椎切除联合稳定性重建。所有患者术后均进行3-24个月的随访,评估并统计2组患者手术前后疼痛VAS评分和脊柱神经功能改善情况,观察患者术后并发症以及脊柱稳定性重建情况。结果所有患者均获随访,平均随访时间(20.26±2.30)个月。27例患者术后疼痛均改善明显,与术前比,2组患者术后3、6个月的VAS评分显著降低(P<0.01)。所有患者神经功能Frankel分级均获得改善或保持原有水平,随访期内均无局部复发及内固定失败病例;所有患者CT均显示植骨融合。结论全脊椎切除联合脊柱稳定性重建可以获得满意的局部控制,有效减轻颈胸段肿瘤患者的痛苦、改善神经功能,应根据肿瘤部位制定个体化手术方式及脊柱重建方案。
Objective To explore the effect of total spinal resection combined with spinal stability reconstruction on neurological function,spinal reconstruction strategy and curative effect of cervicothoracic spinal tumors.Methods 27 patients with cervicothoracic spinal tumors admitted to First Affiliated Hospital of Henan University from January 2014 to December 2016 were divided into control group(n=14)and observation group(n=13)according to different treatment schemes.The control group was given single posterior total spinal resection combined with stability reconstruction,while the observation group was given one-stage anterior and posterior combined spinal resection combined with stability reconstruction.all patients were followed up for 3–24 months after operation.Evaluate and count the improvement of VAS score and Frankel grade before and after operation in two groups,the postoperative complications and spinal stability reconstruction were observed.Results There were 3 cases of pleural rupture,2 cases of transient neurological decline,3 cases of spinal nerve root ligation,residual mild anterior thoracic discomfort.All patients were followed up for an average of(20.26±2.30)months.Postoperative pain was significantly improved in 27 patients.Compared with preoperative pain VAS scores in the two groups were lower at 3 months and 6 months after operation(P<0.01).Neurological function was improved or maintained at the original level in all cases,and there were no cases of local recurrence and internal fixation failure during the follow-up period.Conclusion Total spinal resection combined with spinal stability reconstruction can achieve satisfactory local control,effectively alleviate the pain of patients with cervicothoracic tumors and improve the neurological function of patients.Individualized surgical methods and spinal reconstruction schemes should be formulated according to the location of tumors.
作者
刘志刚
郭庆功
LIU Zhi-gang;GUO Qing-gong(Department of Orthopaedics,First Affiliated Hospital of Henan University,Henan Kaifeng,475001,China)
出处
《颈腰痛杂志》
2020年第1期18-20,25,共4页
The Journal of Cervicodynia and Lumbodynia
基金
国家自然科学基金面上项目(编号:81371981)
关键词
颈胸段脊柱肿瘤
全脊椎切除
脊柱稳定性重建
神经功能
内固定
疼痛
复发
Cervicothoracic spinal tumors
Total spinal resection
Spinal stability reconstruction
Neurological function
internal fixation
pain
recurrence
