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題 名 | Surgical Correction of Postradiation Spinal Deformity=腫瘤放射治療引發脊椎變形手術療法 |
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作 者 | 陳世豪; 陳博光; 黃聰仁; 郭繼陽; 王清貞; | 書刊名 | 長庚醫學 |
卷 期 | 26:3 2003.03[民92.03] |
頁 次 | 頁160-169 |
分類號 | 416.36 |
關鍵詞 | 放射治療引發脊椎變形; 後側凸彎; 威姆氏胚性腎肉瘤; 神經母細胞瘤; Postradiation spinal deformity; Kyphoscoliosis; Wilms'tumor; Neuroblastoma; |
語 文 | 英文(English) |
中文摘要 | 背景:兒童胸腹腔惡性腫瘤切除術後的放射治療,是會引發胸腰椎變形,尤其在骨骼迅速成長時段,脊椎後側凸彎曲度變化特別明顯,早期手術矯正有其必要。然而手術方式依罹病年紀,受犯椎骨發育大小及彎曲柔軟度而有所差異。 方法:過去15年,合計六例腫瘤經放射療法引發眾椎變形者,接受矯正手術,所在病人都追蹤至成年,其成位腫瘤包括三例威姆氏胚或腎肉瘤、兩例神經母細胞瘤,一例惡性淋巴瘤,平均在2.2歲時切除,腫瘤照射量3566rad.,初始發現椎變形是6.1歲,背架矯正無效,接受手術矯正是在11.8歲時,其中三例後位矯正固定術,另三例則須前後位手術處理。 結果:椎體變形曲度之凹側與腫瘤手術切除側同,且後凸面厲害首度大於側彎面,是此類病例特色。四例得到滿意矯正結果,另兩例年紀甚輕者,其饇幹瘦薄、脊椎變形角度大且硬、骨量較輕及合併內科疾病,使得矯正固定器擺置不易,導致融骨不良、鋼停突出頂住皮膚而傷口感染、喪失預期矯正效果,使得脊椎後凸畸形明顯。 結論:腫瘤放射治療引發脊椎變形的表徵是多樣性的,最嚴重會導致脊椎塌陷、後彎角度大且硬。在瘦小患者,脊椎矯正器組合不易,常無法有滿意結果,合併發生假性關節及術後感染。 |
英文摘要 | Back ground: Radiation to the juxtaspinal area in children with malignant tumors induces the appearance of a postradiation spinal deformity (PRSD) with drastic progression during the growth spurt, so surgical correction is mandatory. Methods of surgical treatment depend on the age of the patient, and the type and size of the spinal deformity. Methods: A long-term retrospective survey of 6 patients receiving surgical management of kyphoscoliosis was conducted. The original tumors were 3 Wilms’ tumors, 2 enuroblastomas, and 1 lymphoma. The mean length of time for tumor excision and subsequent radiation was 2.2 years. The total radiation dose averaged 3566 rad. The mean age initial presentation was 6.1 years and that at spinal correction was 11.8 years. Single posterior surgery was performed in 3 cases, while the other 3 required anteroposterior correction due to severe deformity and scar contracture. Results: The curves of PRSD were concave toward the side irradiated, and the kyphotic component was more severely involved than was t he scoliotic component. Foru patients had favorable correction without cure progression. However, in the other 2 younger patients, due to thinness of their back, rigid angulation of the spine, poor bony stock, and medical comorbidity, spinal instrumentation was rather difficult. Postoperative pseudarthrosis and subsequent rod protrusion occurred with progressive kyphosis. Conclusions: PRSDs consist of uncommon developmental vertebral anomalies, of which curved patterns occur in any combination, but most severely involve the presence of collapsing kyphosis and soft tissue contracture. Surgical correction may be less effective, especially if the children are skinny and have low bone stocks. |
本系統中英文摘要資訊取自各篇刊載內容。