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Objective:To retrospectively analyze the patients with spinal metastases who received surgical intervention and summarize the evolution of their clinical and pathological characteristics and surgical methods.Methods:The data of 703 patients with spinal metastases from January 2007 to December 2018 were collected retrospectively. There were 395 males (56.19%, 395/703) and 308 females (43.81%, 308/703) with an average age of 58.14±11.46 years (range 13-84 years). According to the degree of invasion and thoroughness of tumor resection, the surgical methods could be divided into minimally invasive surgery, decompression surgery, separation surgery, piecemeal resection and total en-bloc spondylectomy surgery. The operative methods were minimally invasive surgery in 89 cases (12.66%), decompression surgery in 96 cases (13.66%), separation surgery in 303 cases (43.10%), piecemeal resection in 182 cases (25.89%) and total en-bloc spondylectomy in 33 cases (4.69%). To analyze the trend of the clinical, pathological types and surgical treatment of patients with spinal metastases over the years, and determine the relevant factors affecting the decision-making of surgical methods by multivariate logistic regression.Results:The ratio of male to female was 1.28:1. 39.54% (278/703) of patients with single-segment involvement in 703 patients, 24.04% (169/703) of patients with double-segment metastasis and 36.42% (256/703) of patients with multi-segment metastasis. The most common type of primary tumor was lung cancer (34.57%, 243/703), followed by breast cancer (8.25%, 58/703), myeloma (8.11%, 57/703), gastrointestinal tumor (6.82%, 48/703) and renal malignant tumor (6.40%, 45/703). From 2007 to 2018, there was no significant difference in the percentage change of different age, gender and primary tumor source composition (age: χ 2=14.01, P=0.233; gender: χ 2=35.73, P=0.341; primary tumor: χ 2=120.09, P=0.074). The percentage of patients with sacrococcygeal metastasis decreased from 20.00% in 2008 to 1.89% in 2017 and the difference was statistically significant (χ 2=8.09, P=0.005). The percentage of patients with multi-level metastasis increased from 26.67% in 2008 to 52.83% in 2017, and the difference was statistically significant (χ 2=7.23, P=0.007). The percentage of patients with minimally invasive surgery decreased from 25.00% in 2007 to 5.88% in 2018, and the percentage of patients with segmented resection decreased from 53.33% in 2008 to 10.29% in 2018. The proportion of the two surgical methods showed a significant downward trend, and the differences were statistically significant (minimally invasive surgery: χ 2=1.46, P=0.026; segmented resection surgery: χ 2=19.56, P<0.001). The percentage of patients undergoing separation surgery increased from 13.33% in 2008 to 64.71% in 2018, and the proportion of patients undergoing total en-bloc spondylectomy increased from 0 in 2007 to 10.29% in 2018. Both surgical methods showed a significant growth trend and the differences were statistically significant (separation surgery: χ 2=27.09, P<0.001; χ 2=4.16, P=0.042). Multivariate Logistic regression analysis showed that age, metastatic site, number of metastatic segments, pathological vertebral fractures, Frankel grade, SINS score and VAS score were independent factors influencing surgical decision-making ( P<0.05). Conclusion:With different time and age, the invasiveness and thoroughness of surgery are increasing, which shows that the percentage of patients who underwent separation surgery and to-tal en-bloc spondylectomy is significantly increasing. Age, metastatic site, number of metastatic segments, pathological vertebral fractures, Frankel grade, SINS score and VAS score are independent factors affecting surgical decision-making.
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Objective:To evaluate the clinical value of the New England spinal metastasis score (NESMS) in predicting the prognosis of patients with spinal metastases by retrospectively analyzing the medical records of multicenter spinal metastases in China.Methods:The data of 179 patients with spinal metastases from January 2008 to December 2018 were retrospectively collected. There were 108 males (60.3%) and 71 females (39.7%) with an average age of 59.79±10.88 years old (range 27-84 years). The patient demographic characteristics, primary tumor type, spinal metastases and segments, vertebral pathological fractures, neurological Frankel classification, physical function status, Karnofsky performance scale (KPS), visual analogue score (VAS), the spinal instability neoplastic score (SINS), modified Bauer score, NESMS score, Tomita score and modified Tokuhashi score were collected. The clinical value of NESMS score, Tomita score and modified Tokuhashi score in predicting the survival of patients with spinal metastases were compared. The independent factors affecting survival in these patients were analyzed by Cox proportional hazards regression model.Results:Among the 179 patients, the peak incidence of spinal metastases was in the age group of 61-75 years (45.3%, 81/179) of all patients. Lung cancer was the most common primary tumor (46.9%, 84/179). 40.8% (73/179) of patients had multi-segment metastasisand thoracic spine was the most common site with single-site metastasis (26.3%, 47/179). 28.5% (51/179) of the patients had visceral metastases and 52.0% (93/179) of the patients had extraspinal bone metastases. 31.3% (56/179) of the patients had pathological fractures of the involved vertebral bodies.114 patients received surgical treatment (63.4%). The mortality rates in 3-months, 6-months and 1-year were 22.4% (40/179), 51.4% (92/179) and 77.1% (138/179), respectively. The median survival time of patients with NESMS score of 0-3 was 3, 4, 8, and 10 months respectively with the mean survival time was 3.60±2.10, 6.77±3.39, 9.69±5.71 and 10.53±6.25 months. The 1-year mortality rates were 100% (13/13), 87.5% (42/48), 71.6% (63/88) and 66.7% (20/30) respectively. The consistency of NESMS score, Tomita score and modified Tokuhashi score in predicting survival of all patients was 0.63, 0.58 and 0.55, respectively. For patients with spinal metastases, the NESMS score was better than the Tomita score and modified Tokuhashi score in predicting survival at 3-months (AUC=1.00, 0.63, 0.42) and 6-months (AUC=0.71, 0.63, 0.45). But the accuracy of Tomita score was best in predicting survival at 1-year (AUC=0.66, 0.61, 0.38). Multivariate Cox proportional hazards regression model analysis showed that growth rate of primary tumor, neurological function Frankel score, albumin level and surgical treatment were independent factors affecting the survival time of patients with spinal metastases ( P<0.05). Conclusion:The consistency and accuracy of NESMS score in predicting survival of patients with spinal metastases are better than Tomita score and modified Tokuhashi score, especially in predicting 3- and 6-month survival. The growth rate of primary tumor, Frankel classification, albumin level and surgical treatment were independent factors affecting the survival time of patients with spinal metastases.
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Objective:To observe the epidemiological characteristics of spinal metastases by retrospectively analyzing the medical records of multicenter spinal metastases in China.Methods:Patients with spinal metastases were identified from several clinical centers between January 2007 and July 2019. A total of 1 976 patients were included in this study, including 1 129 males (57.14%) and 847 females (42.86%). The mean age was 58.6±11.6 years (range 13-92 years). The demographic characteristics, primary tumor types, spinal involvement of each patient were summarized and their clinical indicators were obtained by consulting medical records, including: Frankel grade, visual analog scale (VAS), metastatic spinal cord compression (MSCC), Tokuhashi revised score, the spinal instability neoplastic score (SINS), Karnofsky performance status (KPS), and history of malignant tumors. Finally, the intervention influencing factors of patients undergoing surgical treatment were statistically analyzed.Results:The ratio of male to female in 1 976 spinal metastases was 1.33∶1. The median age was 59.0, and most patients (63.71%) were in the ages range of 50-69. The average age of female was younger than male, and the difference was statistically significant. The proportion of male patients over 60 years old was higher than females, and the difference was statistically significant. The most common primary tumor was lung cancer (n=730, 36.94%), followed by unknown origin (n=326, 16.50%), breast cancer (n=159, 8.05%), kidney cancer (n=120, 6.07%), gastrointestinal cancer (n=109, 5.52%), etc. The most common primary tumor was lung cancer in both males and females, followed by unknown origin in males and breast cancer in females. In the past 10 years, the proportion of unknown origin has decreased, and the proportion of breast cancer has increased. According to the Tomita score, 1 284 patients (64.98%) were rapid growth tumors, 211 patients (10.68%) were moderate growth tumors, and 481 patients (24.34%) were slow growth tumors. There were 730 patients (57.14%) in the subgroup of the number<3, the most level of which was lumbar vertebrae, with 368 patients (32.60%). The remaining 847 patients (42.86%) were included in the subgroup of the number≥3, the most level of which was multiple-level of spine, with 617 patients (72.85%). Among the 1 976 patients, spinal cord injury occurred in 50.76% of patients, in which 77.18% of patients developed moderate and above pain, 14.02% of patients appeared metastatic spinal cord compression, and only 28.95% of patients had a clear history of primary tumor. In terms of treatment, 34.92% of patients underwent surgery, 5.97% underwent radiotherapy on spinal metastases, 6.02% underwent chemotherapy, and 1.77% underwent targeted therapy. Preoperative Frankel grade, SINS, and Tokuhashi revised score were important factors affecting the surgical treatment of patients.Conclusion:This study describes the epidemiological characteristics of multicenter spinal metastases in detail, which could assist orthopedic surgeons to understand the clinical characteristics of spinal metastases and was of great significance on guiding the clinical diagnoses and scientific researches.
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Objective To compare the efficiency of gauze packing , internal iliac artery ligation and tran-scatheter arterial embolization for controlling pelvic fracture hemorrhoea .Methods The clinical data of 23 consecu-tive patients with pelvic fracture hemorrhoea were retrospectively analyzed .There were 8 patients who had undergone gauze packing,6 patients undergone artery ligation ,9 patients undergone angioembolization .The ISS,the preoperative shock index ,the operation time of control the shock ,the postoperative blood transfusion ,the days in ICU after opera-tion and the complication were all recorded respectively .Results The operation time of control the shock ,the postop-erative blood transfusion and the days in ICU after operation of the packing group were ( 70.00 ±24.50 ) min, (1 050.00 ±207.02) mL and (10.12 ±1.64) d;the ligation group were (40.83 ±12.01) min,(1 800.00 ± 400.00)mL and (11.17 ±1.72)d;the angioembolization group were (91.67 ±22.64)min,(1 644.44 ±421.64) mL and (7.22 ±1.56)d.The difference between the three groups had statistical significance with the indexes above all(F=10.323,9.265,12.235,all P<0.05),and the ligation group had the shortest operation time to control the shock,the packing group had the least postoperative blood transfusion ,the angioembolization group had the shortest days in ICU after operation .There were 4 cases in the packing group suffering the infection ,the infection rates as high as 50%,one of them died on the 8d;there were one case in the ligation group died of MODS on the 11th day. Conclusion The gauze packing is a sample and effective hemostasis ,suitable for the patients with open fracture and the fist aid for pelvic fracture in the basic level hospitals;the internal iliac artery ligation can control the shock timely but the hemostatic efficacy is not better than the other two kinds of operation; the transcatheter arterial embolization has micro injury and effective hemostatic efficacy ,however ,the strong profession and the lage difficulty may delay the patients'condition .So the doctors should use the methods of hemostasis flexiblely and comprehensively .
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Objective To compare the short and long term effect of knee osteoarthritis treatment with two therapeutic methods which are simple high cut of fibula and arthroscopic lavage debridement combined with fibular osteotomy.Methods Data of 45 consecutive patients with knee osteoarthritis were retrospectively observed and selected,and then they were divided into two groups according to the operation method.23 patients with simple high cut of fibula were selected as the control group,and 22 patients with arthroscopic lavage debridement combined with fibular osteotomy were selected as the observation group.Results The VAS and AKS scores of the control group at the time of 3m,6m,1 2m were (4.1 3 ±0.76)points,(1 07.04 ±21 .53)points;(2.70 ±0.64)points,(1 41 .1 7 ±1 2.57)points;(2.43 ±0.79)points,(1 48.26 ±5.81 )points;and the scores of the observation group were (3.45 ± 0.60)points,(1 26.64 ±1 4.24)points,(2.70 ±0.73)points,(1 46.45 ±7.26)points,(2.41 ±0.85)points and (1 48.26 ±5.81 )points.The differences between the two groups were statistically significant at the time of 3 months after surgery(t =3.32,-3.62,all P 0.05 ). Conclusion The simple high cut of fibula with small trauma,less cost,less surgical difficulty,and long -term clini-cal curative effect is not less than the arthroscopic lavage and debridement combined with fibular osteotomy.There-fore,it should be carried out in the primary hospitals widely.