(30%) [3 7] (VAS) Karnofsky Frankel. Karnofsky <60. [DOI] /j.issn

HTML
DOWNLOAD

Μέγεθος: px

Εμφάνιση ξεκινά από τη σελίδα:

Download "(30%) [3 7] (VAS) Karnofsky Frankel. Karnofsky <60. [DOI] /j.issn"

Φυλλίδος Αντωνιάδης
6 χρόνια πριν
Προβολές:

1 Med J Chin PLA, Vol. 42, No. 5, May 1, [ ] (VAS) Karnofsky Frankel 57 3 VAS (P<0.001) Frankel (P=0.025) Karnofsky (P<0.001) 12.3% 3.5% 24.6% Karnofsky <60 >300ml >300ml Karnofsky <60 Karnofsky [ ] [ ] R681.5 [ ] A [ ] (2017) [DOI] /j.issn Risk factors for perioperative complications of cervical spine metastasis YANG Wen-hua 1,2, JIANG Liang 1*, ZHANG Hua 3, LIU Xiao-guang 1, WEI Feng 1, XU Nan-fang 1, LIU Zhong-jun 1* 1 Department of Orthopaedics, 3 Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing , China 2 Department of Emergency, Beijing Shijitan Hospital, Capital Medical University, Beijing , China * Corresponding author. JIANG Liang, jiangliang@bjmu.edu.cn; LIU Zhong-jun, zjliu@bjmu.edu.cn This work was supported by the Research Grant of Peking University Third Hospital (Y ) [Abstract] Objective To observe the perioperative complications for metastatic cervical tumor, and explore their possible risk factors. Methods From January 2012 to January 2016, 57 patients undergoing surgery for cervical spine metastasis were retrospectively analyzed, who were followed-up for at least 12 months or until death. Data collected included pain (a 10-point visual analogue scale, VAS), Karnofsky performance status score, neurologic status according to Frankel scale, perioperative complications, postoperative mortality and so on. Results The VAS score decreased significantly postoperation (P<0.001). The Frankel grade was significantly improved (P=0.025). The Karnofsky score was also significantly improved (P<0.001). The rate of local recurrence was 12.3%. Perioperative mortality rate (30 days after surgery) was 3.5%. Perioperative complication incidence was 24.6%. Univariate analysis found that comorbidity, preoperative Karnofsky score <60, multisegmental resection, and intraoperative blood loss >300ml were significant risk factors for the complication. Multivariable analysis showed that iintraoperative blood loss >300ml and preoperative Karnofsky score <60 were the independent predictors for the complication. Conclusions Surgical management for cervical spinal metastasis is effective in terms of neurological recovery, pain control, and performance status recovery. However, the surgery had a high risk of complications that special attention should be paid to. Furthermore, complications might be related to preoperative Karnofsky score and intraoperative blood loss. [Key words] cervical vertebrae; neoplasm metastasis; perioperative complications [1] [ ] (Y ) [ ] [ ] ( ) ( ) ( ) [ ] jiangliang@bjmu.edu.cn zjliu@bjmu.edu.cn 17.3% [2] Lee [3] (15%) (55%) (30%) [3 7]

2 [2] ( ) ( ) >3 ) (Halo-vest ) (major complication) (minor complication) [8] ) ( ) 1.2 (visual analogue scale VAS) Karnofsky ( ) Frankel ( ) [9] ( ) ) ( 30d ) [2] ( / ) (<65 65 ) ( / ) ( / ) ( / ) Karnofsky (<60 60 ) (1 >1 ) ( ) ( 130min >130min) ( 300ml >300ml) Karnofsky =60 Karnofsky 1.3 SPSS 18.0 x±s M(Q 1 Q 3 ) χ 2 Fisher t VAS Wilcoxon Frankel Karnofsky Kaplan-Meier logistic ( ) P<0.10 P< Halo-vest ( <12 ) 1 57 ( 1) 1 57 Tab. 1 Clinic data of 57 patients with cervical spine metastatic tumors Item Value Age (year) (1) Male [n(%)] 34(59.6) Radiotherapy [n(%)] 19(33.3) Preoperative 3(5.3) Postoperative 18(31.6) Chemotherapy [n(%)] 24(42.1) Preoperative 6(10.5) Postoperative 20(35.1) WBB layer A [n(%)] 49(86.0) WBB layer D [n(%)] 53(93.0) WBB zones [n(%)] (49.1) 1 3, (7.0) (43.9) WBB levels [n(%)] 1 36(63.2) 2 10(17.5) 3 7(12.3) 4 4(7.0) Comorbidity [n(%)] 26(45.6) Pathologic fracture [n(%)] 39(68.4) Visual analogue scale score 7(5, 9) (2) Karnofsky score 60(50, 70) (2) Frankel grade [n(%)] A 1(1.8) B 3(5.3) C 7(12.3) D 34(59.6) E 12(21.1) Multisegmental resection [n(%)] 21(36.8) Surgical approach [n(%)] Anterior 29(50.9) Posterior 25(43.9) One staged combined 2(3.5) Two staged combined 1(1.8) Operation time (min) 131.0(89.5, 198.5) (2) Intraoperative blood loss (ml) 300(100, 900) (2) Follow-up time (months) 13.0(6.5, 18.0) (2) WBB. Weinstein-Boriani-Biagini; (1)Mean standard deviation. (2)Median (Q 1, Q 3 )

3 Med J Chin PLA, Vol. 42, No. 5, May 1, ~80( ) 1~43 13 (24.6%) (15.8%) (14.0%) (12.3%) (7.0%) (7.0%) (3.5%) (3.5%) (3.5%) (1.8%) (1.8%) (1.8%) (1.8%) (1.8%) 39 (68.4%) C 4 (7 ) C 7 ( %) 36 (63.2%) 54 (94.7%) 45 (78.9%) 26 (45.6%) (5.3%) 6 (10.5%) (3.5%) ( ) 55 (96.5%) (24.6%) (19.3%) ( 2 ) 18~168h 24(19 102)h 3 5 (10.2%) ( 30d ) 2 3.5% 1 15d 1 6d 3 8 (14.0%) 49 (86.0%) 1 21 (36.8%) 36 (63.2%) 27 (47.4%) 30 (52.6%) 6d~25 6(2 11) 7 (12.3%) 3~23 3(3 5) ( 1) 2.3 Karnofsky <60 >300ml Cum survival (%) 1 Kaplan-Meier Fig. 1 The Kaplan-Meier graph of local recurrence-free survival and overall survival 2 Tab. 2 Risk factors for perioperative complications of cervical spine metastasis Variable Time (months) Yes [n(%)] Overall survival Local recurrence Overall survival censored Local recurrence censored (3 ) (3 ) (6 ) (P>0.05) >300ml(OR= %CI 1.38~27.07 P=0.017) Karnofsky <60 (OR= %CI 1.09~16.96 P=0.037) ( 2) 2.4 VAS Frankel Karnofsky 3 VAS ( ) (t=11.05 P<0.001) Frankel 14 (28.6%) 32 (65.3%) 3 Perioperative complication No [n(%)] OR(95%CI) Univariable analysis Age 65 years 4(28.6) 12(27.9) 1.03( ) Male 8(57.1) 26(60.5) 0.87( ) Comorbidity 10(71.4) 16(37.2) 4.22( ) Karnofsky score <60 8(57.1) 11(25.6) 3.88( ) Multisegmental resection 9(64.3) 12(27.9) 4.65( ) Operation time >130min 9(64.3) 20(46.5) 2.07( ) Intraoperative blood loss >300ml 11(78.6) 17(39.5) 5.61( ) Multivariable analysis Karnofsky score < ( ) Intraoperative blood loss >300ml 6.11( ) OR. Odds ratio; CI. Confidence interval P

4 (6.1%) (Z=2.24 P =0.025) Karnofsky 32 (65.3%) 14 (28.6%) 3 (6.1%) (Z=4.38 P<0.001) 3 [2,10-12] Wu [13] 15 VAS (P<0.01) [10] 24 Karnofsky ( ) (t=5.64 P<0.05) Denaro [14] 46 (χ 2 =24.9 P<0.001) VAS (Frankel ) (Karnofsky ) Cho [2] Denaro [14] 10.9%(5/46) 21.7%(10/46) Lee [3] 16.5%(33/200) Boriani [4] % 24.6%(14/57) McDonnell [8] >520ml Matsumoto [5] Tang [14] Boriani [6] (OR= %CI 1.07~3.56) (OR= %CI 1.09~13.17) Boriani [4] Logistic (OR= %CI 1.58~7.35) (OR= %CI 1.03~9.31) (OR= %CI 1.34~14.29) Karnofsky Karnofsky <60 (OR=4.30) >300ml(OR=6.11) Boriani [4] (122/216) 11 Karnofsky Boriani [4] 2 (3.5%) Lee [3] (10.5%) 12 (57.1%) Tatsui [7] (3.4%) 3 Denaro [14] % Cho [2] % 12.3% Karnofsky [1] Xu RS, He WG, Mei Y, et al. Clinical study on 89 SrCl 2 combined with 99 Tc-MDP in the treatment for bone metastases from prostate cancer[ J]. J Logist Univ PAPF (Med Sci), 2016, 25(9): [,,,. 89 SrCl 2 99 Tc-MDP 50 [ J]. ( ), 2016, 25(9): ] [2] Cho W, Chang UK. Neurological and survival outcomes after surgical management of subaxial cervical spine metastases[ J]. Spine (Phila Pa 1976), 2012, 37(16): E969-E977. [3] Lee BH, Park JO, Kim HS, et al. Perioperative complication and surgical outcome in patients with spine metastases: retrospective 200-case series in a single institute[ J]. Clin Neurol Neurosurg, 2014, 122:

5 Med J Chin PLA, Vol. 42, No. 5, May 1, [4] Boriani S, Gasbarrini A, Bandiera S, et al. Predictors for surgical complications of en bloc resections in the spine: review of 220 cases treated by the same team[ J]. Eur Spine J, 2016, 25(12): [5] Matsumoto M, Hikata T, Iwanami A, et al. Major complications and sequelae after total en bloc spondylectomy for malignant spinal tumors[ J]. Neurosurg Q, 2015, 25(4): [6] Boriani S, Bandiera S, Donthineni R, et al. Morbidity of en bloc resections in the spine[ J]. Eur Spine J, 2010, 19(2): [7] Tatsui CE, Suki D, Rao G, et al. Factors affecting survival in 267 consecutive patients undergoing surgery for spinal metastasis from renal cell carcinoma[ J]. J Neurosurg Spine, 2014, 20(1): [8] McDonnell MF, Glassman SD, Dimar JR, et al. Perioperative complications of anterior procedures on the spine[ J]. J Bone Joint Surg Am, 1996, 78(6): [9] Frankel HL, Hancock DO, Hyslop G, et al. The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I[ J]. Paraplegia, 1969, 7(3): [10] Zhou FF, Jiang L, Liu XG, et al. Surgical outcome and strategy for cervical metastasis[ J]. Chin J Orthop, 2013, 33(8): [,,,. [ J]., 2013, 33(8): ] [11] Wu CR, Mao P, Jiang CH, et al. Anterior surgery for middle cervical single metastatic tumors[ J]. J Cervicodynia Lumbodynia, 2015, 36(18): [,,,. [ J]., 2015, 36(18): ] [12] Rao J, Tiruchelvarayan R, Lee L. Palliative surgery for cervical spine metastasis[ J]. Singapore Med J, 2014, 55(11): [13] Wu X, Ye Z, Pu F, et al. Palliative surgery in treating painful metastases of the upper cervical spine[ J]. Medicine (Baltimore), 2016, 95(18): e3558. [14] Denaro V, Di Martino A, Papalia R, et al. Patients with cervical metastasis and neoplastic pachymeningitis are less likely to improve neurologically after surgery[ J]. Clin Orthop Relat Res, 2011, 469(3): [15] Tang B, Ji T, Tang X, et al. Risk factors for major complications in surgery for hypervascular spinal tumors: an analysis of 120 cases with adjuvant preoperative embolization[ J]. Eur Spine J, 2015, 24(10): ( ) ( )

Σχετικά έγγραφα

Mitomycin C application for the prevention of postoperative synechiae formation at the anterior commissure.

Otorhinolaryngologia - Head and Neck Surgery Issue 50, October - November - December 2012, pages 18-22 ORIGINAL REVIEW ARITCLE Mitomycin C application for the prevention of postoperative synechiae formation