脊柱转移瘤硬膜外脊髓压迫症后路减压内固定术后疗效及预后因素分析

发布时间：2018-04-27 21:40

本文选题：转移瘤 + 脊髓压迫　；参考：《安徽医科大学》2017年硕士论文

【摘要】：背景:脊柱转移瘤硬膜外脊髓压迫症(Metastatic epidural spinal cord compression,MESCC)是指恶性肿瘤转移到脊柱或硬膜外间隙导致椎管内脊髓偏离正常解剖位置而引起的继发性脊髓受压,通常有局部或放射性疼痛、运动感觉功能损害、直肠/膀胱括约肌功能紊乱等神经损害表现。MESCC是恶性肿瘤(如甲状腺癌、前列腺癌、肺癌、乳腺癌)晚期常见且严重的一种并发症,它不仅增加病患医疗费用和治疗风险,而且大大降低了患者生活质量、缩短生存期。目的:探讨后路椎板切除椎管减压钉棒系统内固定术治疗MESCC手术疗效及影响术后步行能力和生存的相关预后因素。方法:回顾性分析2010年1月至2014年12月于解放军307医院骨科接受后路椎板切除椎管减压钉棒系统内固定术的67例MESCC患者临床资料。疼痛评价采用视觉模拟评分(Visual analogue scale,VAS)、体力活动状态评价采用美国东部肿瘤协作组(Eastern cooperative oncology group,ECOG)评分、神经功能状态评估采用Frankel分级法、脊髓压迫程度评估采用Bilsky评分。记录患者年龄、原发肿瘤部位、癌症诊断与脊柱转移间隔期、术前内脏转移情况、受累椎体数目、压缩骨折、脊髓受压节段、脊柱外骨转移数量、术前ECOG评分、术前步行功能状态、运动障碍持续时间、术后辅助放疗等。结果:平均随访11.7个月。患者术前与术后4周VAS评分差异有显著统计学意义(5.67±1.67 vs 2.11±1.39分,P0.001);患者术前与术后4周行走率差异有统计学意义(57%vs 78%,P=0.01);术前与术后4周ECOG评分差异有统计学意义(2.79分vs 1.98分P=0.015);术后35例(52%)患者神经功能获得改善(Frankel分级至少提高1级),29例(43%)患者神经功能状态维持不变,3例(5%)的患者神经功能减退,手术前后Frankel分级差异有统计学意义(P0.01)。受累椎体数目、压缩骨折、脊髓受压部位组间术后步行状态差异无显著统计学意义(P0.05);术前ECOG评分、术前行走状态、运动障碍持续时间、Bilsky评分组间术后步行状态差异有统计学意义(P0.05)。单因素分析显示年龄、原发肿瘤类型、术前ECOG评分、术前内脏转移、癌症诊断与发现脊柱转移间隔期、受累椎体数目、术后辅助放疗对术后生存期存在影响(P0.05),多因素分析显示年龄、原发肿瘤部位、术前ECOG评分、术前内脏转移、术后辅助放疗是影响MESCC术后生存期的重要预后因素(P0.05)。结论:有症状的MESCC患者在减少并发症的前提下应当尽早接受手术治疗。后路椎板切除椎管减压钉棒系统内固定术治疗MESCC可以有效缓解疼痛、改善或延缓神经功能损害,提高生活质量。术前ECOG评分低、术前步行状态好、运动障碍持续时间短、脊髓受压程度轻预示术后行走能力好。年龄、原发肿瘤部位、术前ECOG评分、术前内脏转移、术后辅助放疗是MESCC术后生存期的重要预测因素。
[Abstract]:Background: Metastatic epidural spinal cord compression is a secondary compression of the spinal cord caused by the metastasis of malignant tumors to the spinal column or the epidural space, resulting in the deviation of the spinal cord from the normal anatomical position, usually with local or radioactive pain. Motor sensory dysfunction, rectal / bladder sphincter dysfunction, etc. MESCC is a common and severe late stage complication of malignant tumors such as thyroid cancer, prostate cancer, lung cancer, breast cancer, etc. It not only increases patient's medical cost and treatment risk, but also reduces patient's quality of life and life span. Objective: to investigate the curative effect of posterior laminectomy with decompression, nail and rod system fixation for MESCC and the prognostic factors affecting walking ability and survival. Methods: the clinical data of 67 patients with MESCC who underwent posterior laminectomy, spinal canal decompression, nail and rod fixation from January 2010 to December 2014 in the Orthopaedic Department of Chinese PLA 307 Hospital were retrospectively analyzed. Visual analogue scale was used to evaluate pain, Eastern cooperative oncology group was used to evaluate physical activity status, Frankel was used to evaluate neurological function, and Bilsky was used to evaluate spinal cord compression. Patients' age, primary tumor location, cancer diagnosis and spinal metastasis interval, preoperative visceral metastasis, number of involved vertebrae, compression fracture, compression segment of spinal cord, number of extraspinal bone metastasis, preoperative ECOG score were recorded. Preoperative walking status, duration of dyskinesia, postoperative adjuvant radiotherapy, etc. Results: the average follow-up was 11.7 months. There was significant difference in VAS score between preoperative and postoperative 4 weeks (5.67 卤1.67 vs 2.11 卤1.39), significant difference in walking rate between preoperative and postoperative 4 weeks (P 0.01), and significant difference in ECOG score between preoperative and postoperative 4 weeks (2.79 vs 4 weeks after operation). The neurological function was improved in 35 patients after operation. The Frankel grade was improved in at least 29 patients.) the neurological function of the patients remained unchanged in 3 patients. The difference of Frankel grade before and after operation was statistically significant (P 0.01). There was no significant difference in the number of involved vertebrae, compression fracture and spinal cord compression site between the two groups (P 0.05). ECOG score before operation, walking state before operation, There was significant difference in walking status between the two groups in the duration of motor disorder and Bilsky score (P 0.05). Univariate analysis showed age, type of primary tumor, preoperative ECOG score, preoperative visceral metastasis, interval between diagnosis and detection of spinal metastasis, number of involved vertebrae. Multiple factor analysis showed that age, location of primary tumor, preoperative ECOG score, preoperative visceral metastasis and postoperative adjuvant radiotherapy were important prognostic factors for postoperative survival of MESCC. Conclusion: patients with symptomatic MESCC should receive surgical treatment as soon as possible while reducing complications. Posterior laminectomy, decompression, nail and rod system fixation for MESCC can effectively relieve pain, improve or delay the damage of nerve function, and improve the quality of life. The preoperative ECOG score was low, the preoperative walking state was good, the duration of motor disorder was short, and the degree of spinal cord compression was a good predictor of postoperative walking ability. Age, primary tumor site, preoperative ECOG score, preoperative visceral metastasis and postoperative adjuvant radiotherapy were important predictors of survival after MESCC.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R738

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