本文選題：轉(zhuǎn)移瘤 + 脊髓壓迫　； 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：背景:脊柱轉(zhuǎn)移瘤硬膜外脊髓壓迫癥(Metastatic epidural spinal cord compression,MESCC)是指惡性腫瘤轉(zhuǎn)移到脊柱或硬膜外間隙導(dǎo)致椎管內(nèi)脊髓偏離正常解剖位置而引起的繼發(fā)性脊髓受壓,通常有局部或放射性疼痛、運(yùn)動(dòng)感覺功能損害、直腸/膀胱括約肌功能紊亂等神經(jīng)損害表現(xiàn)。MESCC是惡性腫瘤(如甲狀腺癌、前列腺癌、肺癌、乳腺癌)晚期常見且嚴(yán)重的一種并發(fā)癥,它不僅增加病患醫(yī)療費(fèi)用和治療風(fēng)險(xiǎn),而且大大降低了患者生活質(zhì)量、縮短生存期。目的:探討后路椎板切除椎管減壓釘棒系統(tǒng)內(nèi)固定術(shù)治療MESCC手術(shù)療效及影響術(shù)后步行能力和生存的相關(guān)預(yù)后因素。方法:回顧性分析2010年1月至2014年12月于解放軍307醫(yī)院骨科接受后路椎板切除椎管減壓釘棒系統(tǒng)內(nèi)固定術(shù)的67例MESCC患者臨床資料。疼痛評(píng)價(jià)采用視覺模擬評(píng)分(Visual analogue scale,VAS)、體力活動(dòng)狀態(tài)評(píng)價(jià)采用美國(guó)東部腫瘤協(xié)作組(Eastern cooperative oncology group,ECOG)評(píng)分、神經(jīng)功能狀態(tài)評(píng)估采用Frankel分級(jí)法、脊髓壓迫程度評(píng)估采用Bilsky評(píng)分。記錄患者年齡、原發(fā)腫瘤部位、癌癥診斷與脊柱轉(zhuǎn)移間隔期、術(shù)前內(nèi)臟轉(zhuǎn)移情況、受累椎體數(shù)目、壓縮骨折、脊髓受壓節(jié)段、脊柱外骨轉(zhuǎn)移數(shù)量、術(shù)前ECOG評(píng)分、術(shù)前步行功能狀態(tài)、運(yùn)動(dòng)障礙持續(xù)時(shí)間、術(shù)后輔助放療等。結(jié)果:平均隨訪11.7個(gè)月�；颊咝g(shù)前與術(shù)后4周VAS評(píng)分差異有顯著統(tǒng)計(jì)學(xué)意義(5.67±1.67 vs 2.11±1.39分,P0.001);患者術(shù)前與術(shù)后4周行走率差異有統(tǒng)計(jì)學(xué)意義(57%vs 78%,P=0.01);術(shù)前與術(shù)后4周ECOG評(píng)分差異有統(tǒng)計(jì)學(xué)意義(2.79分vs 1.98分P=0.015);術(shù)后35例(52%)患者神經(jīng)功能獲得改善(Frankel分級(jí)至少提高1級(jí)),29例(43%)患者神經(jīng)功能狀態(tài)維持不變,3例(5%)的患者神經(jīng)功能減退,手術(shù)前后Frankel分級(jí)差異有統(tǒng)計(jì)學(xué)意義(P0.01)。受累椎體數(shù)目、壓縮骨折、脊髓受壓部位組間術(shù)后步行狀態(tài)差異無(wú)顯著統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)前ECOG評(píng)分、術(shù)前行走狀態(tài)、運(yùn)動(dòng)障礙持續(xù)時(shí)間、Bilsky評(píng)分組間術(shù)后步行狀態(tài)差異有統(tǒng)計(jì)學(xué)意義(P0.05)。單因素分析顯示年齡、原發(fā)腫瘤類型、術(shù)前ECOG評(píng)分、術(shù)前內(nèi)臟轉(zhuǎn)移、癌癥診斷與發(fā)現(xiàn)脊柱轉(zhuǎn)移間隔期、受累椎體數(shù)目、術(shù)后輔助放療對(duì)術(shù)后生存期存在影響(P0.05),多因素分析顯示年齡、原發(fā)腫瘤部位、術(shù)前ECOG評(píng)分、術(shù)前內(nèi)臟轉(zhuǎn)移、術(shù)后輔助放療是影響MESCC術(shù)后生存期的重要預(yù)后因素(P0.05)。結(jié)論:有癥狀的MESCC患者在減少并發(fā)癥的前提下應(yīng)當(dāng)盡早接受手術(shù)治療。后路椎板切除椎管減壓釘棒系統(tǒng)內(nèi)固定術(shù)治療MESCC可以有效緩解疼痛、改善或延緩神經(jīng)功能損害,提高生活質(zhì)量。術(shù)前ECOG評(píng)分低、術(shù)前步行狀態(tài)好、運(yùn)動(dòng)障礙持續(xù)時(shí)間短、脊髓受壓程度輕預(yù)示術(shù)后行走能力好。年齡、原發(fā)腫瘤部位、術(shù)前ECOG評(píng)分、術(shù)前內(nèi)臟轉(zhuǎn)移、術(shù)后輔助放療是MESCC術(shù)后生存期的重要預(yù)測(cè)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 鹵1.67 vs 2.11 鹵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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R738

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 雷明星;劉耀升;劉蜀彬;;骨轉(zhuǎn)移瘤發(fā)病的細(xì)胞生物學(xué)機(jī)制與細(xì)胞分子靶向治療[J];中華損傷與修復(fù)雜志(電子版);2015年02期

2 韓秀鑫;王國(guó)文;張超;多健;廖志超;;121例脊柱轉(zhuǎn)移瘤手術(shù)治療的療效分析[J];中華骨科雜志;2014年11期

3 Ferno Ruiz Santiago;Alicia Santiago Chinchilla;Luis Guzmán álvarez;Antonio Luis Pérez Abela;Maria del Mar Castellano García;Miguel Pajares López;;Comparative review of vertebroplasty and kyphoplasty[J];World Journal of Radiology;2014年06期

4 李彥;姜亮;劉曉光;劉忠軍;韋峰;吳奉梁;黨y;;肺癌脊柱轉(zhuǎn)移瘤的手術(shù)治療療效及生存分析[J];北京大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2014年01期

5 劉蜀彬;劉耀升;李鼎鋒;范海濤;槐建業(yè);郭鈞;王磊;張平;崔秋;姜維浩;曹云岑;江寧;隋佳紅;張斌;周舉;;脊柱轉(zhuǎn)移瘤癱瘓狀態(tài)與影像學(xué)特征相關(guān)因素分析[J];中國(guó)骨與關(guān)節(jié)雜志;2010年04期

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