摘要
目的:探讨一期后路全脊椎切除、环脊髓减压、植骨及内固定治疗胸椎肿瘤的手术指征及临床效果.方法:对11例累及胸椎(按改良Tomita分期为Ⅳ期和Ⅴ期)的肿瘤患者采取一期后路全脊椎切除、环脊髓减压、植骨及内固定术,其中大块自体髂骨植骨9例,异体皮质骨笼+自体松质骨椎体间植骨2例;脊柱内固定应用CD 2例,TSRH 8例,AXIS 1例.结果:手术时间225～425min,平均285min,术中出血750～3200ml,平均1650ml.边缘或整块切除3例,病灶内分块+边缘切除8例.术后经8～36个月(平均18.3个月)随访,2例甲状腺癌转移患者1例于术后8个月发生多处转移,器官衰竭而死亡;另1例于术后14个月局部软组织内肿瘤复发及其它部位转移而放弃治疗,术后21个月死亡;1例滑膜软骨肉瘤于术后10个月发现肺部多处转移,术后17个月死亡;余8例存活,随访中无局部复发、转移或内固定失效等.7例术前伴脊髓神经功能损害者,术后6例获显著改善.结论:对累及胸椎的Ⅳ期和Ⅴ期肿瘤采取一期后路全脊椎切除、稳定性重建,创伤小、并发症少.
Objective:To investigate the clinical indications and effect of one-stage total spondylectomy?circumspinal cord decompression?bone grafting and internal fixation through a single posterior approach for thoracic spinal tumors.Method:11 cases with thoracic spinal tumors which included 3 cases with modified Tomita stage Ⅳ,8 cases with stage Ⅴ were treated by one-stage total spondylectomy?circumspinal cord decompression?bone grafting and internal fixation through a single posterior approach.Bone was grafted with strut autogenous corticocancellous bone in 9 cases and with allogeneic bone-cage filled with autografts in 2 cases.The spine was fixed with CD in 2cases,TSRH in 8 cases,AXIS in 1 case.The followed-up was ranged from 8 to 36 months with an average of 18.3 months.Result:The average blood loss was 1650ml(range 750~3200ml) and the average time of operation was 285min(range 225~425min).Marginal excision of tumors was performed in 3 cases,intralesional and marginal excision in 8 cases.Of 2 cases with metastatic tumors from thyroid carcinoma,1 case died of metastases,and multiple system failure in 8 months;the other case refused further treatment because of local recurrence and metastasis of other location in 14 months and died in 21 months after surgery.1 case with synoviochondrosacoma was found metastases of lung in 10 months and died in 17 months after surgery.No recurrence,metastasis and complication related with internal fixation was found in other 8 cases.Obvious improvement of neurological function was obtained in 6 cases of 7 cases after surgery.Conclusion:One-stage total spondylectomy and reconstruction of the stability through a single posterior approach is an effective treatment for patients with thoracic spinal tumors classified as stage Ⅳ or Ⅴ of modified Tomita staging.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
2004年第8期465-469,共5页
Chinese Journal of Spine and Spinal Cord
关键词
胸椎
肿瘤
全脊椎切除:后路
手术治疗
Thoracic vertebrae
Tumor
Total spondylectomy
Posterior procedure
Surgical treatment
