| Background:With the continuous improvement of medical level,the survival of patients with malignant tumors is getting longer and longer,and the incidence of bone metastasis is also gradually increasing.The spine is the most common site of bone metastases,which can cause pain,spinal instability,pathological fractures,and metastatic spinal cord compression.Surgical intervention for spinal metastases is often necessary to prevent and treat complications.The surgical methods for spinal metastases mainly include minimally invasive surgery,separation surgery and total spondylectomy.Total spondylectomy is the total resection of the affected vertebrae(usually no more than 2 consecutive segments of the affected vertebrae)to achieve the purpose of extensive resection of tumor tissue.Total spondylectomy can be divided into en-bloc resection and piecemeal resection according to the surgical method.At present,there are few studies on the clinical effects of total spondylectomy and reconstruction for patients with thoracolumbar metastatic tumors and the comparison of the two surgical resection methods.Objective:To investigate the clinical effects of total spondylectomy and reconstruction for thoracolumbar metastatic tumors via the one-stage posterior approach,to compare the perioperative indicators,clinical effects,survival situation,local recurrence rate and distant metastasis rate and perioperative complication of total spondylectomy with en bloc resection and piecemeal resection for thoracolumbar metastatic tumors if there is a difference.Methods:A total of 38 patients with thoracolumbar metastatic tumor treated with total spondylectomy and reconstruction via the one-stage posterior approach in the Department of Orthopedics of Henan Provincial People’s Hospital from January 2018 to January 2022,which were divided into en-bloc group and piecemeal group according to the surgical method,including 15 cases in the en-bloc group and 23 cases in the piecemeal group.Perioperative indicators(operative time,intraoperative blood loss and intraoperative blood transfusion),visual analogue scale(VAS)of pain,American Spinal Injury Association(ASIA)spinal cord injury classification,Eastern Cooperative Oncology Group Performance Status(ECOG-PS)scale,median survival time,local recurrence rate and distant metastasis,and perioperative complications.Results:(1)In the en-bloc resection group,the operative time was(7.39±0.53)h,the intraoperative blood loss was(1613.33±299.09)ml,and the intraoperative blood transfusion was(1046.67±243.10)ml;In the piecemeal resection group,the operative time was(5.63±0.63)h,the intraoperative blood loss was(2504.35±427.18)ml,and the intraoperative blood transfusion was(1547.83±345.58)ml.The operative time of the en-bloc resection group was significantly higher than that of the piecemeal resection group,and the intraoperative blood loss and transfusion volume of the piecemeal resection group were significantly higher than that of the en-bloc resection group.The perioperative indicators of different surgical methods were compared between the two groups,and the differences were statistically significant(P<0.05).(2)VAS scores in the en-bloc resection group decreased from(8.07±1.03)points before surgery to(2.13±0.83)points after surgery,the difference was statistically significant(P<0.05),VAS scores after surgery in the en-bloc resection group were significantly relieved than that before surgery;VAS scores in piecemeal resection group before surgery decreased from(8.04±1.07)points to(2.26±0.81)points after surgery,and the difference was statistically significant(P <0.05),VAS scores after surgery in the piecemeal resection group were significantly relieved than that before surgery.The VAS scores of different surgical methods were compared between the two groups,and the differences were not statistically significant(P>0.05).(3)Among the 15 patients in the en-bloc resection group,there was no change in neurological function before and after surgery in 1 case of grade C and 2 cases of grade E in ASIA classification,and the neurological function of the remaining 12 patients was recovered after surgery compared with that of this group,with statistically significant differences within the group(Z=-3.276,P < 0.05).Among the 23 patients in the piecemeal resection group,there was no change in neurological function before and after surgery in 1 case of grade B and 3 cases of grade E in ASIA classification,and the neurological function of the remaining 19 patients recovered after surgery compared with that of this group,with statistically significant differences within the group(Z=-4.185,P<0.05).The ASIA grade of different surgical methods was compared between the two groups,and the differences were not statistically significant(P>0.05).(4)Among the 15 patients in the en-bloc resection group,there was no change in the ECOG-PS scale before and after surgery in 1 patient with 3 points and 1 patient with 4 points,while the quality of life of the remaining 13 patients was improved after the operation,and the difference was statistically significant within the group(Z=-3.272,P<0.05).Among the 23 patients in the piecemeal group,there was no change in the ECOG-PS physical status scale before and after surgery in 2 patient with 4 points,while the quality of life of the remaining 21 patients was improved after operation compared with that of the group,the difference was statistically significant(Z=-4.072,P<0.05).The ECOG-PS scale of different surgical methods was compared between the two groups,and the differences were not statistically significant(P>0.05).(5)The median survival time of the en-bloc resection group was 32 months,and that of the piecemeal resection group was 12 months.The survival time of the en-bloc group was longer than that of the piecemeal group.Survival analysis log-rank test: x2 =4.184,P =0.041<0.05,There were significant differences between the two groups.(6)The local recurrence rate was 43.5%(10/23)in the piecemeal resection group and 6.7%(1/15)in the en-bloc resection group,and the comparison of the local recurrence rate between the two groups was statistically significant(P<0.05),The local recurrence rate in the en-bloc resection group was significantly lower than that in the piecemeal resection group.The distant metastasis rate was 13.0%(3/23)in the piecemeal resection group and 6.7%(1/15)in the en-bloc resection group,and there were no statistical differences in the distant metastasis between the two groups(P>0.05).(7)In the en-bloc resection group,the incidence of perioperative complications was 40.0%,and6 patients had perioperative complications,including 3 cases of pleural effusion,1 case of cerebrospinal fluid leakage,1 case of incision infection,and 1 case of lower limb venous thrombosis.In the piecemeal resection group,the incidence of perioperative complications was 39.1%,and 9 cases had perioperative complications,including 2 cases of pleural effusion,1 case of cerebrospinal fluid leakage,2 cases of incision infection,1 case of internal fixation failure,and 3 cases of lower limb venous thrombosis.The total incidence of perioperative complications and the incidence of each complication of different surgical methods were compared between the two groups,and the differences were not statistically significant(P>0.05).Conclusions:1)Total spondylectomy and reconstruction via the one-stage posterior approach can improve the pain,nerve function,the quality of life of patients with thoracolumbar metastatic tumor to varying degrees,but there was no difference in the clinical effects of the two surgical methods in improving pain,nerve function and quality of life.2)Although the operative time of total en bloc spondylectomy is longer than that of total piecemeal spondylectomy,it is better in reducing intraoperative blood loss and intraoperative blood transfusion,reducing local recurrence rate of the tumor and prolonging survival time than that total piecemeal spondylectomy.3)There was no difference in perioperative complication rate and distant metastasis rate between the total en bloc spondylectomy and piecemeal spondylectomy. |
