摘要
目的 :探索脊柱肿瘤切除术后稳定性重建的方法与效果。方法 :本组对 2 8例脊柱肿瘤实施了椎体切除 ,扇形半脊椎切除、附件切除和全脊椎切除四种术式 ,同时采用了椎体间植骨 ,人工椎体及前、后路内固定重建技术。结果 :全组病人局部疼痛及放射痛缓解 ,13例截瘫患者中 11例肌力均有不同程度改善。 11例原发良性肿瘤中 2例术后 4和10年复发 ,1例伴恶变 ,均再次治疗。 11例原发恶性肿瘤中 2例术后 9和 12个月死亡 ,1例植骨块脱出 ,再次手术 ,另 1例局部肿瘤复发截瘫加重 ,再次手术但神经功能无恢复。内固定并发症有 :钉尾螺母松动脱落 1例 ,椎弓根螺钉位置不良 4例计 9枚。结论 :应用椎体间植骨、人工椎体并辅以前、后路内固定可有效重建脊柱稳定性 ,促进患者术后早期康复。
Objective: To observe the clinical outcomes of various spinal reconstruction methods for spinal tumors. Methods:Twenty eight cases were included in this series, 14 males and 14 females, aged from 5 to 71 years, the means was 39.3 years. 11 cases were benign and 11 cases were malignant, the remaining 6 were metastases. Four surgical procedures were applied to various surgical stages of spinal tumor lesions:(1)vertebrectomy in 9 cases, (2)sagittal resection in 3 cases,(3)posterior arch resection in 2 cases and (4) corporectomy in 14 cases, The methods of stability reconstruction were:(1) anterior instrumentation in 3 cases,(2) posterior instrumentation in 17 cases and (3) circumferential spinal reconstruction combined with anterior and posterior instrumentation in 5 cases. Results: All patients had a pain relieve and motor function improved in 11 of 13 cases. Two giant cell tumors had local recurrence, one of them became malignant, both of them were submitted to a second curettage and resection. Two malignant cases died 9 and 12 months later, respectively. One C 5 chondrosarcoma had bone graft dislocation undergone second surgical procedure, the remaining one had recurrence of L 1 myeloma with deterioration of neurologic function. He was given second currettage and posterior stability, but there was no neurologic function improvement. The complications of instrumentation were:(1)dislocation in one nut of pedicle screw,(2)mal position of 9 pedicle screws in 4 cases. Conclusions: Strut bone graft and artificial vertebral body implant combined with anterior, posterior or circumferential instrumentation is efficacious in reconstruction of spinal stability.
出处
《中国矫形外科杂志》
CAS
CSCD
2002年第9期843-846,共4页
Orthopedic Journal of China
关键词
脊柱肿瘤
稳定性
治疗
外科手术
Spinal neoplasms
Stability
Surgical management
