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中华老年骨科与康复电子杂志 ›› 2018, Vol. 04 ›› Issue (01) : 14 -19. doi: 10.3877/cma.j.issn.2096-0263.2018.01.004

所属专题: 文献

骨肿瘤

肺癌脊柱转移瘤的手术疗效分析
陆惠根1, 黄鑫2, 张中伟3, 叶招明2,()   
  1. 1. 310009 浙江大学医学院附属第二医院骨科;314000 嘉兴市第二医院骨科
    2. 310009 浙江大学医学院附属第二医院骨科
    3. 314000 嘉兴市第二医院骨科
  • 收稿日期:2016-12-08 出版日期:2018-02-05
  • 通信作者: 叶招明

The curative effect of surgical treatment for spinal metastases of lung cancer

Huigen Lu1, Xin Huang2, Zhongwei Zhang3, Zhaoming Ye2,()   

  1. 1. Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University, Hangzhou 310009, China; Department of Orthopaedics, The Second Hospital of Jiaxing, Jiaxing 314000, China
    2. Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University, Hangzhou 310009, China
    3. Department of Orthopaedics, The Second Hospital of Jiaxing, Jiaxing 314000, China
  • Received:2016-12-08 Published:2018-02-05
  • Corresponding author: Zhaoming Ye
  • About author:
    Corresponding author: Zhao Mingye, Email:
引用本文:

陆惠根, 黄鑫, 张中伟, 叶招明. 肺癌脊柱转移瘤的手术疗效分析[J]. 中华老年骨科与康复电子杂志, 2018, 04(01): 14-19.

Huigen Lu, Xin Huang, Zhongwei Zhang, Zhaoming Ye. The curative effect of surgical treatment for spinal metastases of lung cancer[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2018, 04(01): 14-19.

目的

探讨肺癌脊柱转移瘤的手术治疗效果。

方法

回顾性分析2012年1月至2016年5月在浙江大学附属第二医院骨肿瘤中心及浙江省嘉兴市第二医院骨科住院治疗且病理诊断明确的肺癌脊柱转移瘤患者72例。其中男性48例(66.7%),女性24例(33.3%),平均年龄(61±4)岁,39例(54.2%)术前生存期评分为6分,27例(37.5%)7分,6例(8.3%)8分。随访并比较患者手术前后疼痛视觉模拟评分(VAS)及Frankel分级变化情况,评价手术疗效。

结果

65例患者获得满意随访(90.2%)。随访时间6~12个月,平均(8.5±1.6)个月,VAS评分由术前(5.9±1.1)分降至术后(2.7±1.2)分,差异有统计学意义(t=21.24,P<0.05)。术后Frankel分级明显改善,差异有统计学意义(Z=-4.978,P<0.05),42例术前有神经功能障碍者5例未恢复,37例部分恢复,差异有统计学意义(Z=-4.978,P<0.05)。

结论

手术治疗肺癌脊柱转移瘤可有效缓解患者疼痛程度,改善神经功能。

Objective

To investigate the curative effect of surgical treatment for spinal metastases of lung cancer.

Methods

A retrospective study was performed in 72 cases of spinal metastases of lung cancer treated in The Second Affiliated Hospital of Zhejiang University and The Second Hospital of Jiaxing. There were 48 males (66.7%) and 24 females (33.3%) with an average age of 61±4 years. The preoperative survival score were evaluated and 39 cases (54.2%) were 6 points, 27 cases (37.5%) were 7 points and 6 cases (8.3%) were 8 points. The Visual Analogue Scale (VAS) score and Frankel classification of two group were compared before and after surgery.

Results

Sixty-five patients (90.2%) were followed-up with a timespan of 6-12 months (8.5±1.6 months on the average). The VAS score decreased to (2.7±1.2) from preoperatively (5.9±1.1), with statisticl significance (t=21.24, P<0.05). The postoperative Frankel score was significantly improved, with statisticl significance (Z=-4.978, P<0.05). 5 patients among 42 cases with neurological deficit were not improved, 37 cases were partially recovered (Z=-4.978, P<0.05).

Conclusion

Surgical treatment can relieve the pain and improve the neurological function of patients with spinal metastases of lung cancer.

图1~7 女性,53岁,肺癌胸12转移,胸背部疼痛明显。术前脊髓压迫,但没有神经症状。SINS评分12分。图1~2 胸椎正侧位片未见明显骨质破坏;图3 胸腰椎CT重建可见胸12椎体前中柱溶骨性骨质破坏,并伴椎管内软组织影,脊髓压迫,但无神经症状;图4 CT平扫见胸12椎体前中柱及双侧椎弓根骨质溶骨性破坏,椎管前方骨质破坏缺损;图5 核磁共振见胸12椎体及双侧椎弓根稍高信号影,骨质破坏;图6~7 予以后路减压,肿瘤分块切除,前方钛网骨水泥填充,后路长节段内固定
图8~15 女性,60岁,肺癌伴L3转移。硬膜外脊髓压迫明显,伴有不全瘫,左下肢肌力3级,神经根性疼痛。图8 腰椎正位片见L3左侧椎弓根周围结构显示不清;图9 腰椎侧位片未见明显骨质破坏表现;图10 核磁共振T2抑脂像可见L3椎体后缘、棘突及椎管后方稍高信号影,硬膜受压;图11 CT横断位片可见左侧横突前方及椎管左侧异常软组织影,棘突两侧少许异常软组织影;图12 核磁共振横断位可见L3棘突、左侧横突、椎体左后方及左侧椎管内稍高信号影,左侧椎弓根、横突几椎体左后方骨质破坏;图13~15 予以后路肿瘤切除,椎管减压,前方肿瘤刮除,骨水泥填充,内固定。术后神经根性疼痛缓解,下肢肌力明显改善,恢复为5级
表1 42例肺癌脊柱转移患者手术前后Frankel分级变化
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