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雷明星,刘耀升,刘蜀彬,崔秋,蒋伟刚,周明.后路减压内固定术结合术中125I粒子永久性植入治疗脊柱转移瘤脊髓压迫症[J].脊柱外科杂志,2017,15(3):134-140.
后路减压内固定术结合术中125I粒子永久性植入治疗脊柱转移瘤脊髓压迫症     点此下载全文 (Fulltext)
雷明星1  刘耀升1  刘蜀彬1  崔秋1  蒋伟刚1  周明2
1. 中国人民解放军第307医院骨科, 北京 100071;
2. 中国人民解放军第307医院核医学科, 北京 100071
基金项目:首都临床特色课题研究基金(Z171100001017176,Z161100000516101)
DOI:10.3969/j.issn.1672-2957.2017.03.002
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摘要:
      目的 观察后路减压内固定术结合术中125I粒子永久性植入治疗脊柱转移瘤脊髓压迫症(MESCC)的疗效。方法 回顾性分析2012年1月-2014年12月在本院行后路减压内固定术结合术中125I粒子植入(研究组,n=20)或术后常规放疗(对照组,n=40)的MESCC病例,观察并比较两组患者术后疼痛视觉模拟量表(VAS)评分、卡氏功能状态量表(KPS)评分、神经功能预后、生存期和并发症发生率。结果 两组患者术后VAS评分均低于术前(P<0.05),KPS评分均高于术前(P<0.05)。研究组术后1周、1个月和3个月VAS评分明显低于对照组(P<0.05),术后6个月两组VAS评分相近。研究组术后1周和1个月KPS评分明显高于对照组(P<0.05),术后3个月、6个月两组KPS评分相近。研究组和对照组术后分别有90.0%(18/20)和75.0%(30/40)的患者具备行走能力,中位生存期分别为7.0个月(95%可信区间:4.3~13.7个月)和6.6个月(95%可信区间:3.8~9.0个月),并发症发生率分别为10.0%(2/20)和15.0%(6/40),两组差异均无统计学意义(P>0.05)。结论 后路减压内固定术结合术中125I粒子植入治疗MESCC在短期疼痛缓解和一般体力状态改善方面,疗效优于后路减压内固定术联合术后常规放疗。
关键词:脊柱  肿瘤转移  减压术,外科  碘放射性同位素  放射化疗
Surgical decompression and spine stabilization combined with permanent 125I seed implantation in treatment of metastatic epidural spinal cord compression    Fulltext
LEI Ming-xing1  LIU Yao-sheng1  LIU Shu-bin1  CUI Qiu1  JIANG Wei-gang1  ZHOU Ming2
1. Department of Orthopaedics, 307 th Hospital of PLA, Bejing 100071, China;
2. Department of Nuclear Medicine, 307 th Hospital of PLA, Bejing 100071, China
Fund Project:
Abstract:
      Objective To investigate the efficacy of surgical decompression and spine stabilization combined with permanent 125I brachytherapy seed implantation in the treatment of metastatic epidural spinal cord compression (MESCC).Methods MESCC patients treated with surgical decompression and spine stabilization combined with permanent 125I brachytherapy seed implantation (study group, n=20) or surgical decompression and spine stabilization followed by radiotherapy (control group, n=40) were retrospectively analyzed between January 2012 and November 2014.Visual analogue scale (VAS) score, Karnofsky performance scale (KPS) score, neurological outcome, survival prognosis, and rates of complications were compared between the 2 groups.Results Postoperative VAS scores were significantly lower than preoperative those, and postoperative KPS scores were significantly higher than preoperative those in both groups (P<0.05).The VAS scores in the study group were significantly lower than the those in the control group at 1 week, 1 months, and 3 months after surgery (P<0.05), and similar in both groups at postoperative 6 months.The KPS scores in the study group were significantly higher than those in the control group at 1 week, and 1 months after surgery (P<0.05), and similar in both groups at postoperative 3 and 6 months.There were 18(90.0%) and 30(75.0%) patients having the ability to walk after surgery in the study and control group, respectively, with no significant difference.The median survival time was 7.0 months (95% confidence interval:4.3-13.7 months) and 6.6 months (95% confidence interval:3.8-9.0 months) in the study and control group, respectively, with no significant difference (P<0.05).Complication occurred in 2(10.0%) patients in the study group and 15.0%(6/40) in the control group, with no significant difference (P>0.05).Conclusion Surgical decompression and spine stabilization combined with permanent 125I brachytherapy seed implantation is superior to the treatment with decompressive surgery followed by radiotherapy in MESCC patients in terms of short term pain relief and improvement of performance status.
Keywords:Spine  Neoplasm metastasis  Decompression, surgical  Iodine radioisotopes  Radiochemistry
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