目的 探讨胸腰椎转移瘤后路手术方式的选择，分析比较两种不同后路手术方式选择的适应证和临床疗效。 方法 选择2011年7月～2017年10月,60例接受后路手术治疗胸腰椎转移瘤的患者进行回顾性分析，男性 32例，女性 28 例，平均年龄 60.7 岁（39~77 岁），胸椎35例，腰椎25例，共90个椎体。所有患者均具有严重的胸或腰部疼痛，不同程度的椎体压缩骨折脊柱不稳和（或）脊髓压迫。均具备手术指征，根据手术方式分为两组，A组42例患者，行单纯后路椎管减压、骨水泥椎体成形钉棒系统内固定术，B组18例患者，行单纯后路椎体次全切全钛网置换钉棒系统内固定术。比较两组患者手术时间、术中出血量、术后并发症、根据VAS评分评估患者术后第3d的疼痛缓解情况、根据Frankel分级评估患者在术后2周时的神经功能恢复情况、根据KPS评分评估患者术后2周时的功能状态改善情况、根据ECOG评分评价其活动状态等。术后每3个月随访一次，行X光片，均进行VAS评分、Frankel分级、KPS评分、ECOG评分。术后患者均接受放疗和（或）化疗及靶向药物治疗。平均随访15个月（3~45个月）。 结果 所有患者无术中死亡。A组的手术时间平均210min 短于B组310min（P <0.05）、A组平均出血量 1050ml少于B组的 1800 ml（P <0.05）；所有患者的 VAS 评分在术后3d均显著降低，KPS评分分值上升，ECOG评分术后均有改善，两组间疼痛缓解和功能状况改善比较差异无统计学意义 (P ＞0. 05)。A组脊髓损伤的患者术后 78% Frankel 分级得到改善，B组为 77%。A组8例发生并发症(19%)，B组4例 (22%)。A组中位生存时间为 14 个月，B组为 15 个月 (P ＞0. 05)。结论：两种后路术式均得到了满意的术后效果，对脊柱转移瘤患者采取合适的手术方式，能够有效缓解疼痛，改善神经功能，更好的改善脊柱转移瘤患者的生活质量。

Objective: To explore the posterior surgical methods of thoracolumbar metastases, and analyze their indications and clinical efficacies. Methods: Follow up 60 patients suffering from thoracolumbar metastases that were treated with posterior surgical operations from July?2011?to October?2017.?They were 32 males and?28?females?,and the average age was 60.7 years old (39~77 years old). According to the treatment, 35 patients of thoracic metastases?and?25 patients of lumbar metastases were included in our study. Totally, 90 vertebral bodies were conducted the treatment. All patients suffered?severe thoracic or lumbar pain, accompanied by vertebral compression fractures, spinal instability?and/or spinal cord repression.?They were divided into two groups,?group A?had 42 patients underwent simple posteriorvertebral canal decompression,?vertebroplasty?and? internal fixation, and 18 patients in group B were conducted simple posterior?corpectomy, titanium mesh?replacement and?internal fixation. The surgery time,?intraoperative?bleeding volume and postoperative complications were investigated. All patients"" pain scale, neural?functional, functional?improvement and activity were also observed. The X-ray examination was performed every 3 months after the operation. The VAS?scores,?Frankel?grades,?KPS?scores and?ECOG?scoring systems were used for the evolution.?After surgery, all patients underwent? radiotherapy?and/or?chemotherapy?and?targeted drug therapy.?The average follow-up?time?was 15 months (3~45 months).?Results: All patients were safely operated. The average?surgery time of group A was?210 min,?it is?shorter than that of group B?310 min (P<0.05).?Compared with group B, the mean bleeding volume of group A 1050ml was less (P <0.05). The?VAS scores of all?patients?were decreased significantly, but the?KPS scores were increased and the?ECOG?scores were improved obviously at 3 days after surgery. The differences between two groups in terms of?pain relief and functional improvement?were not?statistically?significant?(P>0.05).?The?Frankel?grading of?78% of patients with spinal cord injury?in group A?was improved?after surgery, meanwhile,?77%?in?group B.?8 patients?in group A?(19%)?and?4 patients?in?group B?(22%)had complications. The?median survival time?in group A?was?14?months?and?15 months?in group?B?(P＞0.05).Conclusion: ?Both posterior surgical?methods of thoracolumbar metastases were safe and effective treatment in improving the neural function, the quality of life and pain relief.

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