经皮椎弓根螺钉内固定联合可扩张管状牵开器下肿瘤切除治疗脊柱转移瘤的效果

doi:10.19723/j.issn.1671-167X.2023.03.020

摘要/Abstract

摘要：

目的: 探讨经皮椎弓根螺钉内固定联合可扩张管状牵开器下肿瘤切除治疗脊柱转移瘤的临床疗效。方法: 对2017年6月至2019年10月在北京大学第一医院骨科接受经皮椎弓根螺钉内固定联合可扩张管状牵开器下肿瘤切除治疗的12例脊柱转移瘤患者进行回顾性研究，收集患者围手术期临床资料、术后辅助治疗情况、生存期以及内固定失败情况，比较术前、术后视觉模拟评分(visual analog scale，VAS)、卡氏(Karnofsky)评分和美国东部肿瘤协作组(Eastern Cooperative Oncology Group，ECOG)评分的变化。结果: 所有患者均手术顺利，平均手术时间、术中失血量和输血量分别为(247.0±14.6) min、(804.2±222.3) mL和(500.0±100.0) mL，平均伤口引流量为(240.8±79.3) mL，患者均在术后早期拔除引流管并下地活动，平均(3.2±0.3) d，术后平均住院(7.8±0.8) d。所有患者均获得随访，随访时间6~30个月，平均生存期(13.6±2.4)个月。随访期间有2例患者出现螺钉移位，均获得有效治疗。术前VAS为(7.1±0.2)分，术后3个月和6个月分别为(2.3±0.1)分和(2.8±0.4)分，差异有统计学意义(P < 0.05)。术前卡氏评分为(59.2±1.9)分，术后3个月和6个月分别为(75.0±1.9)分和(74.2±3.1)分，差异有统计学意义(P < 0.05)。术前ECOG为(2.3±0.2)分，术后3个月和6个月分别为(1.7±0.1)分和(1.7±0.2)分，差异有统计学意义(P < 0.05)。结论: 严格把握适应证，经皮椎弓根螺钉内固定联合可扩张管状牵开器手术能够有效缓解脊柱转移瘤患者的临床症状并改善生活质量，临床疗效满意。

关键词: 脊柱, 转移瘤切除术, 最小侵入性外科手术, 经皮椎弓根螺钉内固定

Abstract:

Objective: To investigate the effectiveness of percutaneous pedicle screw fixation combined expandable tubular retractor in the treatment of patients with spinal metastases. Methods: In the study, 12 patients of spinal metastases treated with percutaneous pedicle screw fixation combined expandable tubular retractor in our hospital were retrospectively reviewed between June 2017 and October 2019. Among the 12 patients, 9 were males and 3 were females; the median age was 62.5 years [(65.1±2.9) years]. The decompression segment of 7 patients was located at the lower thoracic spine (including 1 patient with incomplete paraplegia) and the decompression segment of 5 patients was located at the lumbar spine; Tomita score was 6.0±0.6. Perioperative data of the patients were reviewed. Visual analog scale (VAS score), Karnofsky score, and Eastern Cooperative Oncology Group (ECOG) score were compared before and after surgery. The patient's survival, adjuvant treatment, and internal fixation failure were observed in the follow-up period. Results: All the 12 patients had a successful operation with percuta-neous pedicle screw fixation combined expandable tubular retractor. The average operative time, blood loss, and blood transfused of the patients were (247.0±14.6) min, (804.2±222.3) mL and (500.0±100.0) mL, respectively. The average amount of drainage was (240.8±79.3) mL. Drainage tubes were pulled out early postoperative [(3.2±0.3) d], allowing early mobilization. The patients discharged (7.8±0.8) d postoperative. All the patients were followed up for 6-30 months, and the average overall survival time was (13.6±2.4) months. During the follow-up period, 2 patients experienced screw displacement, the internal fixation was stable after conservative treatment and no revision surgery was performed. The VAS of the patients was 7.1±0.2 before surgery, which decreased to 2.3±0.1 and 2.8±0.4 at 3 and 6 months after surgery (P < 0.05). The Karnofsky score of the patients was 59.2±1.9 before surgery, which increased to 75.0±1.9 and 74.2±3.1 at 3 and 6 months after surgery (P < 0.05). The ECOG of the patients was 2.3±0.2 before surgery, which decreased to 1.7±0.1 and 1.7±0.2 at 3 and 6 months after surgery (P < 0.05). Conclusion: For selected patients with spinal metastases, minimally invasive surgical treatment of spinal metastases (percutaneous pedicle screw internal fixation combined with expandable tubular retractor) can effectively relieve the clinical symptoms and improve the quality of life, with satisfactory clinical outcome.

Key words: Spinal, Metastasectomy, Minimally invasive surgical procedures, Percutaneous pedicle screw fixation

中图分类号:

R738.1

崔云鹏,施学东,刘佳,米川,王冰,潘元星,林云飞. 经皮椎弓根螺钉内固定联合可扩张管状牵开器下肿瘤切除治疗脊柱转移瘤的效果[J]. 北京大学学报（医学版）, 2023, 55(3): 530-536.

Yun-peng CUI,Xue-dong SHI,Jia LIU,Chuan MI,Bing WANG,Yuan-xing PAN,Yun-fei LIN. Percutaneous pedicle screw fixation combined expandable tubular retractor in the treatment of spinal metastases[J]. Journal of Peking University (Health Sciences), 2023, 55(3): 530-536.

图/表 7

表1

12例脊柱转移瘤患者的人口学特征和术前资料"

Items	Minimally invasive spine surgery (n=12)
Gender
Female	3
Male	9
Age/years, ${\bar x}$ ±s	65.1±2.9
Primary tumor
Renal	3
Lung	3
Prostate	2
Multiple myeloma	2
Uroepithelium	1
Esophageal	1
Bilsky compression grade
1c	3
2	8
3	1
ASIA grade
D	1
E	4
Lesion locate below L₁	7
Location of the lesion
Lumbar	7
Thoracic	5
Tomita score, ${\bar x}$ ±s	6.0±0.6
SINS score, ${\bar x}$ ±s	10.3±0.3
Karnofsky score, ${\bar x}$ ±s	59.2±1.9
ECOG grade, ${\bar x}$ ±s	2.3±0.2
VAS, ${\bar x}$ ±s	7.8±0.2

表1

图1

表2

图2

表3

12例脊柱转移瘤患者的随访数据"

Items	Minimally invasive spine surgery (n=12)
Overall survival/months, ${\bar x}$ ±s	13.6±2.4
Screw displacement	2 (16.7%)
ASIA grade
D	0
E	5
Lesion locate below L₁	7
Subsequent treatment
Targeted therapy	4
Systemic therapy	4
Radiotherapy	2
None	2
Number of deaths	3 (25%)

表3

表4

12例脊柱转移瘤患者术前、术后6个月的VAS及卡氏评分"

Items	Minimally invasive spine surgery (n=12)
VAS, ${\bar x}$ ±s
Preoperation	7.1±0.2
Discharge	2.6±0.1^*
3 months postoperation	2.3±0.1^*
6 months postoperation	2.8±0.4^*
Karnofsky score, ${\bar x}$ ±s
Preoperation	59.2±1.9
3 months postoperation	75.0±1.9^*
6 months postoperation	74.2±3.1^*
ECOG grade, ${\bar x}$ ±s
Preoperation	2.3±0.2
3 months postoperation	1.7±0.1^*
6 months postoperation	1.7±0.2^*

表4

图3

参考文献 25

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Items	Minimally invasive spine surgery (n=12)
Operative time/min	247.0±14.6
Tumors originating from the renal	282.7±33.7
Others	235.1±15.0
Estimated blood loss/mL	804.2±222.3
Tumors originating from the renal	1 900.0±458.3
Others	438.9±79.8
Number of patients transfused	10 (83.3%)
Blood transfusion/mL	500.0±100.0
Tumors originating from the renal	666.7±352.8
Others	444.5±80.1
Perioperative complications
Dural injury	2 (16.7%)
Urinary tract infection	0
Deep vein thrombosis	0
Pneumonia	0
Screw malposition	0
Wound problem	0
Total amount of drainage/mL
All patients	240.8±79.3
Patients without dural injury	127.5±24.4
Postoperative drainage tube removal/d	3.2±0.3
Postoperative hospital stay/d	7.8±0.8

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