摘要
目的:探讨胸腰椎肿瘤全脊椎切除术后脊柱稳定性的重建方式。方法:1993￣2003年我院治疗各类胸腰椎(T5￣L5)肿瘤患者72例,其中全脊椎切除、随访2年以上、没有肿瘤复发和转移且有完整影像学资料者12例,骨巨细胞瘤9例,单发浆细胞性骨髓瘤2例,非何杰金氏淋巴瘤1例。一期前后路联合全脊椎切除11例,次全脊椎切除1例,以5种不同方式重建,分别为前路内固定加后路短节段经椎弓根内固定(ASP)5例、前路内固定加后路多节段Luque环内固定(AMP)4例、单纯后路短节段经椎弓根内固定(SP)1例、单纯后路多节段经椎弓根内固定(MP)1例、单纯前路内固定(A)1例。观察术前、术后即刻及末次随访时矢状面Cobb角度变化、植骨融合情况、有无植骨骨折及下沉等并发症。结果:随访2.5￣13年,平均6.6年。ASP方式重建的5例患者矢状面Cobb角丢失0°～7°,平均2.4°,植骨全部融合,无植骨骨折,1例因术中损伤终板而出现人工椎体轻度下沉。AMP方式重建的4例患者矢状面Cobb角丢失0°～9°,平均5°,植骨全部融合,无植骨骨折或下沉;其中1例术后1.5年植骨融合后取出后方固定,仅保留前方固定,出现植骨骨折及后凸畸形。SP或MP方式重建的2例患者矢状面Cobb角分别丢失12°和13°,植骨块均骨折。次全脊椎切除A方式重建的1例患者矢状面Cobb角无丢失,植骨融合且无植骨骨折及下沉。结论:本组病例较少,但初步可以看出ASP和AMP是全脊椎切除后坚强的重建方式,能够使植骨顺利融合,防止Cobb角度丢失。但ASP能够减少固定节段、保留运动单元,是更好的固定方式。SP和A不宜单独应用于全脊椎切除后稳定性重建。
Objective：To explore five different spinal stability reconstruction methods after total spondylectomy due to thoracolumbar tumor.Method：From 1993 to 2003,72 patients with thoracolumbar （T5-L5） tumors were treated in our hospital.Among them,12 cases accepted spondylectomy and were followed up thoroughly. All of the 12 cases had complete radiological materials.Follow-up ranged from 2.5 years to 13 years,averaging 6.6 years.No recurrence or metastasis was noted among them.The tumors in this group consisted of 9 giant cell tumors,2 solitary plasmacytomas and one non-Hodgkin lymphoma.One stage anterior and posterior approach spondylectomies were performed in 11 patients and subspondylectomy in one patient.Five different spinal stability reconstructions were used after the resection,including （1）anterior instrumentation with shortsegmental posterior instrumentation（ASP） in 5 cases; （2）combined anterior instrumentation with muhisegmental posterior instrumentation（AMP） in 4 cases;（3）short-segmental posterior instrumentation（SP） in one case;（4） multilevel posterior instrumentation （MP） in one case;（5）anterior instrumentation （A） in one case.Kyphosic Cobb angles were measured in the lateral radiographic films before and immediate after the surgery and at the final follow-up.Status of bony fusion and the subsidence of the intervertibral strut were documented.Result：The Cobb angles in 5 ASP cases lost 0°-7°,averaging 2.4°.Bony fusion were evidenced in all cases and no graft fractures were found.Mild subsidence of the mesh occurred in one case due to the endplate injury in the surgery.In the 4 cases of AMP group,the Cobb angles lost 0°-9°,averaging 5°.Bony fusion was obtained in all cases without fracture and implant subsidence.One patient undergoing AMP reconstruction had his posterior implant taken out after 1.5 years of his initial surgery.While left anterior instrumentation unintact after the second surgery.As a result,the graft was found fracture and the kyphosis developed.The Cobb angle losses in SP and MP patients were 12° and 13° separately.All with grafts failure.No Cobb angle loss was found in the subspondylectomy and anterior instrumented patient.The graft was fused well with no graft fracture or implant subsidence.Conclnsions：ASP and AMP provide rigid stability after total spondylectomy,which improve the bony fusion rate and prevent the Cobb angle loss and the occurence of kyphosis.But ASP is preferred because it can save more movement segments.SP and A are not suitable to use alone after the total spondylectomy.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
2006年第11期807-811,共5页
Chinese Journal of Spine and Spinal Cord
关键词
脊柱肿瘤
全脊椎切除术
脊柱融合术
内固定
Spinal neoplasms
Spondylectomy
Spinal fusion
Spinal instrumentation
