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1、Diagnosisandmanagementofmetastaticspinedisease脊柱转移性疾病的诊断和治疗DanielM.Sciubba,M.D.,RoryJ.Petteys,M.D.,MarkB.Dekutoski,M.D.,CharlesG.Hsher,M.D.,F.R.C.S.C.,MichaelG.Fehlings,M.D.,Ph.D.,F.R.C.S.C.,StephenL.Ondra,M.D.,LaurenceD.Rhines,M.D.,and2yaL.Gokaslan,M.D.With
2、continuedgrowthoftheelderlypopulationandimprovementsincancertherapies,thenumberofpatientswithsymptomaticspinalmetastasesislikelytoincrease,andthisisaconditionthatcommonlyleadstodebilitatingneurologicaldysfunctionandpain.Advancementsinsurgicaltechniquesofrese
3、ctionandspinalreconstruction,improvementsinclinicaloutcomesfollowingvarioustreatmentmodalities,generallyincreasedoverallsurvivalinpatientswithmetastaticspinedisease,andarecentrandomizedtrialbyPatchellandcolleaguesdemonstratingthesuperiorityofacombinedsurgica
4、l/radiotherapeuticapproachoveraradiotherapy-onlystrategyhaveledmanytosuggestincreasinglyaggressiveinterventionsforpatientswithsuchlesions.Optimalmanagementofspinalmetastasesencompassesnumerousmedicalspecialties,includingneurosurgery,orthopedicsurgery,medical
5、andradiationoncology,radiology,andrehabilitationmedicine.Inthisreview,theclinicalpresentation,diagnosis,andmanagementofspinalmetastaticdiseasearediscussed.Ultimately,thegoaloftreatmentinpatientswithspinalmetastasesremainspalliative,andclinicaljudgmentisrequi
6、redtoselecttheappropriatepatientsforsurgicalintervention.随着人口老龄化的加剧和癌症治疗方法的改进，有症状的脊林转移性疾病患者H渐增加，此类患者通常伴有神经功能障碍和疼痛。外科切除和脊柱重建技术的进步，多种治疗模式改善了临床治疗效果，使脊柱转移性疾病患者总生存率逐渐增加。Patchell及其同事最近进行的一项随机对比实验证实外科/放疗联合疗法比单纯放疗更具优越性，导致对此类患者采取积极干预的建议FI益增多。脊柱转移性病变的最伴治疗手段需要多洋科协作，包括神
7、经外科、骨外科、肿瘤内科、放疗科、放射科以及康复科。本文就脊柱转移性疾病的临床表现、诊断和治疗搖施做一综述。故后，脊柱转移性疾病患者的治疗冃标冇待斟酌，临床上要严格把握手术适应症。KeyWords:cancer,metastasis,spine,surgery,radiationtherapy关键词：癌症转移脊柱外科放疗Morethan1.4millionnewcasesofcancerwillbediagnosedthisyearintheUS.5Roughlyhalfofthesepatientswille
8、ventuallydieoftheirdisease,aratethathasremainedrelativelyunchangedforthepasthalfcentury.Complicationsrelatedtocancercaused565,650deathsin2008・Thelungsandliverarethemostfrequentsitesofdistantmeta
