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目的 :探讨颈胸段脊柱肿瘤全脊椎切除的手术方式、脊柱重建策略及治疗效果。方法 :回顾性分析我院自2008年1月~2013年12月行全脊椎切除术治疗的颈胸段脊柱肿瘤病例11例,病理诊断包括骨巨细胞瘤5例,骨母细胞瘤1例,Ewing肉瘤1例,浆细胞性骨髓瘤1例,甲状腺滤泡型转移癌2例,前列腺转移癌1例。患者均有不同程度的胸背部疼痛,术前VAS评分为7.45±0.82分;脊髓损伤神经功能Frankel分级B级1例,C级3例,D级6例,E级1例。所有病例术前根据Tomita脊柱肿瘤外科分期评估均为间室外病变。4例C7~T1段肿瘤行一期前后联合入路全脊椎切除,前方钛网、钛板重建;7例T2~T4段肿瘤行单一后路整块全脊椎切除(TES),前方单纯钛网重建。两种术式后方均为钉棒系统重建。观察患者术中术后并发症以及脊柱重建稳定性情况。结果:手术时间298~573min,平均423.9min;术中失血量800~3800ml,平均2077ml。4例术中胸膜破裂,2例术后神经功能一过性下降,7例术中结扎病椎神经根,残留轻度胸前区不适。所有患者均获随访,平均随访34.7个月,1例前列腺转移癌患者死亡,其余均无局部复发。术后患者疼痛明显改善,VAS评分由术前7.45±0.82分下降至术后2.55±0.69分(P<0.05)。术后神经功能2例(术前D级1例,E级1例)保持原有水平,余均获得改善,均未出现内固定失败。结论:全脊椎切除治疗颈胸段脊柱肿瘤可以获得满意的局部控制,缓解疼痛,改善神经功能,应根据肿瘤位于颈胸段脊柱近端(C7~T1)或远端(T2~T4)而制定个体化手术方式及脊柱重建策略。
Objective: To investigate the surgical approach of total spondylectomy for cervical and thoracic spinal tumors, spinal reconstruction strategies and therapeutic effects. Methods: A retrospective analysis of 11 cases of cervical thoracic spinal tumors treated in our hospital from January 2008 to December 2013 was retrospectively analyzed. Pathological diagnosis included 5 cases of giant cell tumor of bone, 1 case of osteoblastoma, Ewing’s sarcoma in 1 case, plasma cell myeloma in 1 case, thyroid follicular metastasis in 2 cases, prostate metastasis in 1 case. Patients had different degrees of chest and back pain, preoperative VAS score was 7.45 ± 0.82 points; spinal cord injury Frankel grade B, 1 case, C grade in 3 cases, D grade in 6 cases, E grade in 1 case. All cases were preoperatively classified as extra-ventricular lesions based on surgical staging of Tomita’s spinal tumors. Four cases of C7-T1 tumors were treated with total anterior and posterior approach total spondylectomy, anterior titanium mesh and titanium plate reconstruction. Seven of them had single posterior block total spondylectomy (TES) and anterior simple titanium mesh reconstruction. Two kinds of surgical procedures are the rear bar system reconstruction. Observe the intraoperative postoperative complications and stability of spine reconstruction. Results: The operation time ranged from 298 to 573 minutes with an average of 423.9 minutes. The intraoperative blood loss was from 800 to 3800 ml with an average of 2077 ml. 4 cases of pleural rupture, 2 cases of transient postoperative neurological decline, 7 cases of intraoperative ligation of the nerve root of the vertebrae, residual mild chest precordial discomfort. All patients were followed up for a mean follow-up of 34.7 months. One patient with metastatic prostate cancer died without any local recurrence. The postoperative pain was significantly improved. The VAS score decreased from 7.45 ± 0.82 points preoperatively to 2.55 ± 0.69 points postoperatively (P <0.05). Two cases of postoperative neurological function (preoperative D grade in 1 case, E grade in 1 case) to maintain the original level, and I were improved, no failed internal fixation. CONCLUSIONS: Total spondylotomy for cervical thoracic spine tumors can achieve satisfactory local control, relieve pain and improve neurological function, and should be based on the tumor at the proximal (C7 ~ T1) or distal (T2 ~ T4) Individualized surgery and spine reconstruction strategy.