| Objective: Spinal tumor can generally be divided into primary tumors and metastatic tumors according to the source.Primary spinal tumor is rela-tively rare, its incidence rate is only 0.4%.Primary spinal tumor includes osteochondroma,osteoblastoma,hemangioma,neurofibroma,schwannoma, an-eurysmal bone cyst,giant cell tumor,chondrosarcoma,osteosarcoma,myeloma and so on. Spinal metastases are more common than Primary spinal tumors. According to statistics, the incidence rate of Spinal metastases is 35 to 40 times the primary spinal tumor. By order the origin of metastatic tumors is breast cancer,lung cancer,prostate cancer,kidney cancer,thyroid cancer, gas-trointestinal cancer,gynecological cancer,melanoma.Spine is the third part where malignant tumors transfer to besides the lung and the liver.Spinal tu-mors mostly invade thoracic vertebra and lumbar vertebra,can cause patho-logical fractures,spinal deformity,spinal cord compression, etc.Patients often experience symptoms such as pain, damage of neural function.These seriously symptoms affect the quality of life. In order to improve the quality of life of patients and relieve spinal cord compression,surgical treatment has become the consensus of the treatment of spinal tumors.The surgical method for tho-racic and lumbar tumors is generally divided into three categories:Anterior vertebral body tumor resection;Posterior tumor resection;Combined anterior and posterior tumorectomy.Anterior surgery is difficult to achieve the purpose of en bloc tumor excision because of the blind corner during tumor resection. Combined anterior and posterior surgery is mainly applied to low lumbar tu-mors and when tomor with large soft tissue mass invade front-spine organs or major vessels needing anterior release.Posterior surgery is sufficient to strip the vertebral tumors,can remove the tumor completely.In this paper, we ana-lyse the clinical curative effect of 38 patients in the third hospital of hebei medical university with posterior-alone tumorectomy for thoracal and lumbar tumors through the retrospective analysis.Methods: We make a retrospective analysis of clinical data of 38 patients with thoracal and lumbar tumors from September 2012 to December 2014 in the third hospital of hebei medical university,who were treated by posteri-or-alone tumorectomy.There were 19 males and 19 females aging 17 to 76 years old.There were 15 cases of primary tumors,including 5 multiple myelo-ma,2 giant cell tumors,1 hemangioma,2 chondrosarcoma,1 meningioma,1 Ewing’s sarcoma,1 histocytic sarcoma,1 maglignant schwannoma,1 aneurys-mal bone cyst.There were 23 cases of metastatic tumors.Tumor origin:lung cancer 8,cervical cancer 2, kidney cancer 2,esophageal cancer 2,liver cancer 2,gastric cancer 1,Colon cancer 1,breast cancer 1,other 4.In the preoperative and postoperative 2 weeks and postoperative 1 month,the patient’s pain levels were evaluated by the visual analogue scale(VAS).In the preoperative and postoperative 1 month and postoperative 6 month,the patient’s functional conditions were classified by the Karnofsky performance score(KPS).In preoperative and postoperative 1 month,the patient’s neurologic conditions were evaluated by the Frankel Grade.The data was analysed by using SPSS 19.0 statistical software.The VAS scores of preoperative and postoperative 2 weeks and 1 month were compared by paired T-test.The KPS scores of pre-operative and postoperative 1 month and postoperative 6 month were com-pared by paired T-test.The data information was expressed with mean standard deviation( sx ±).Set α=0.05,there was statistically significant when P < 0.05 for the difference.The data of Frankel Grade in postoperative 1 month was compared with the data in preoperative.Results: The surgeries of 38 patients were successfully completed.The opration time: 135min~450min,the mean time was(268.6±65.3)min.The amount of bleeding during surgery:700ml ~ 5000 ml,the mean amount of bleeding was(1936.8±1074.6)ml.The amount of blood transfusion during surgery: 800ml~5400ml, the mean amount of blood transfusion was(1757.9±1045.1)ml.Follow-up time: 3 months to 30 months,the mean fol-low-up time was 10.5 months.During the follow-up period,local recurrence was found in 2 cases of patients,2 lung cancer patients died because of the failure of breathe,1 liver patient died because of brain metastases.1 VAS Score The VAS score in preoperative of 38 patients was 7.43±0.68,the VAS score in postoperative 2 weeks was 4.56±1.54,the VAS score in postoperative 1 month was 3.30±1.79.We compared the VAS score between preoperation and postoperative 2 weeks by using paired T-test.The VAS score showed statistical significance(t=14.46,P<0.01).In the same way,we compared the VAS score between preoperation and postoperative 1 month.The VAS score showed statistical significance(t=16.63,P<0.01).Patient’s pain was obviously relieved after surgery.2 KPS score The KPS score in preoperative of 38 patients was 60.27±13.43,the KPS score in postoperative 1 month was 73.24±14.34,the KPS score in postoperative 6 month was 76.45±18.89.We compared the KPS score between preoperation and postoperative 1 month by using paired T-test.The KPS score showed statistical significance(t=-11.9,P<0.01).In the same way,we compared the KPS score between preoperation and postopera-tive 6 month.The KPS score showed statistical significance(t=- 6.3,P<0.01).The quality of life was obviously improved after surgery.3 Frankel Grade The Frankel Grade in preoperative of 38 patients:Grade A 2,Grade B 5,Grade C 15,Grade D 15,Grade E 1.The Frankel Grade in postoperative 1 month:Grade C 7,Grade D 13,Grade E 18.The proportion of Grade D and E in preoperative was 42.1%(16/38).The proportion of Grade D and E in postoperative 1 month was 81.6%(31/38).The patient’s neural function was recovered in different level after surgery.Conclusion: Posterior-alone tumorectomy can be applied to treating tu-mors of thoracic and lumbar vertebral body;We can choose different ways of posterior surgery to treat thoracic and lumbar tumors according to the spinal tumor surgical stagingsystem;The posterior-alone tumorectomy for thoracic and lumbar tumors can obviously relieve patient’s pain,improve quality of life,remove spinal cord compression caused by tumor,recover neural function in different level. |
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