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- 轉移性脊椎病變:由前位手術作椎體切除和以Zielke's VDS加上骨水泥填充固定的的外科療法
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題名 | 轉移性脊椎病變:由前位手術作椎體切除和以Zielke's VDS加上骨水泥填充固定的的外科療法=Metastatic Spine Disease: Surgical Treatment by Anterior Corpectomy and Ziekel's VDS Fixation |
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作者 | 陳力輝; 陳文哲; 牛自健; 施俊雄; Chen, Lih-huei; Chen, Wen-jer; Niu, Chi-chien; Shih, Chun-hsiung; |
期刊 | 長庚醫學 |
出版日期 | 19961200 |
卷期 | 19:4 1996.12[民85.12] |
頁次 | 頁320-324 |
分類號 | 416.61 |
語文 | chi |
關鍵詞 | 轉移性脊椎病變; 神經缺失; 手術; Metastatic spine disease; Neurologic deficit; Surgery; |
中文摘要 | 背景:脊椎是癌轉移至骨骼最常見的部位。一旦發現脊椎轉移病變,通常是屬於癌症末期,也常為一般病人和家屬所放棄。但對於特定的病人應可經由手術減輕病痛,恢復神經功能,重建脊椎穩定度,以期改善病人餘生之生活品質。國內少有這些報告,所以特別提出本院病例分析報告。 方法:由於脊椎轉移病變通常是侵犯到椎體而造成脊椎之破壞、崩陷和神經壓迫,本文之手術法是以前位手術做椎體切除,清除壓迫脊髓神經之腫瘤,和以骨泥填補合併Zielke's VDS固定之。由1984年至1993年間,共有40位脊椎轉移癌病人接受此手術;男性28位,女性12位,平均年齡為53.2歲。24例發生在胸椎,12例腰椎,4例合併胸腰椎。原發性癌包括肺癌10例,直結腸6例,肝癌5例,甲狀腺癌4例,查不出原發部位8例。術前術後之臨床症狀疼痛是否減輕、神經功能恢復與否及病人存活時間也被評估。 結果:所有病人術前皆有嚴重背痛,術後減輕有89%。30位神經缺失,其神經功能改善者有70%。有8位大小便困難中,6位也獲得改善。病人存活率超過三個月占82%,超過六個月為60%,大於一年占40%。 結論:我們認為前位手術予以椎體切除及內固定,用來治療特定選擇病人發生轉移性脊椎病變,具有疼痛減輕、神經功能恢復之療效,實可視為對此類病人好而有效的輔助療法之一。 |
英文摘要 | The spine is the common site of skeletal metastases. The goal of surgical treatment of metastatic spine disease is to improve the quality of remaining life, by relief of pain, the preservation or restoration of neurologic function, and reconstruction of the spinal stability. From 1984 through June 1993, 40 consecutive patients underwent surgical treatment by anterior corpectomy, and bone cement with VDS fixation for corporal metastatic disease. There were 28 men and 12 women. The average age was 53.2 years, range from 21 to 76 years. Twenty-four patients had metastasis to the thoracic spine, 12 to the lumber spine, and 4 had both thoratic and lumber metastases. The primary malignancies were lung cancers in 10 cases, colorectal carcinomata in 6, hepatomas in 5, thyroid cancers in 4, cancer of stomach, renal, breast, nasopharynx, long bone, skin, cervical in 1 case respectively. A primary carcinoma was never identified in 8 patients. In the present series, 4 patients died within one month, 36 patients were allowed for follow-up study. Thirty-two patients (89%) attained pain relief. Thirty patients presented with neurologic compromise. After operation, neurologic improvement was noted in 21 (70%). No patient's neurologic function deteriorated secondary to surgical intervention. We conclude that anterior corpectomy to decompress neural encroachment with VDS and cement fixation to stabilize the collapsed spine is an adjunctive treatment to reduce pain and restore the neurologic function in these highly selected patients. |
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