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目的探讨后路全脊椎切除术同期重建脊柱稳定性治疗胸、腰椎肿瘤的方法及临床疗效。方法 2004年6月-2008年7月,采用经后路全脊椎切除减压并后路钛网植骨椎弓根螺钉重建脊椎稳定性治疗胸、腰椎肿瘤患者14例。其中男11例,女3例;年龄36～60岁,平均47.2岁。病程3～15个月。病变节段位于T3 1例,T4 3例,T8 3例,T9 2例,T10 3例,T12 1例,L1 1例。其中骨巨细胞瘤3例,成骨细胞瘤1例,骨肉瘤2例,转移性肿瘤8例。根据病变范围及区域,按Tomita等分型标准:Ⅱ型1例,Ⅲ型5例,Ⅳ型3例,Ⅴ型5例。术前脊髓功能按Frankel分级,B级3例,C级4例,D级5例,E级2例。结果术后切口均Ⅰ期愈合,无血管、神经损伤等早期并发症。14例均获随访,随访时间11～64个月,平均32.5个月。患者术后局部疼痛症状均明显缓解。术后6～8个月复查X线片、CT显示植骨均获BridwellⅠ级骨性融合。术后10个月脊髓功能由Frankel B级恢复至D级2例,C级恢复至D级1例,余9例恢复至E级;行走功能均无明显障碍。2例患者因发生脑部和肝转移,分别于术后11个月和15个月死亡;1例骨肉瘤患者术后16个月发生肺转移而死亡;1例骨肉瘤患者术后8个月局部复发;余未见肿瘤复发和转移。患者内固定物均牢靠,无松动断裂,钛网无移位塌陷,脊椎无失稳现象。结论后路全脊椎切除同期脊柱重建治疗胸、腰椎肿瘤具有创伤相对较小、瘤椎切除完整、局部复发率低、脊髓减压充分等优点。
Objective To investigate the methods and clinical effects of posterior total spondylectomy for reconstructing spinal stability in the treatment of thoracic and lumbar tumors. Methods From June 2004 to July 2008, 14 patients with thoracic and lumbar tumors were treated with posterior total spondylectomy and posterior titanium mesh grafting pedicle screw reconstruction of spinal stability. Including 11 males and 3 females; aged 36 to 60 years, mean 47.2 years. Duration of 3 to 15 months. The lesion was located in T3 1 case, T4 3 cases, T8 3 cases, T9 2 cases, T10 3 cases, T12 1 case, L1 1 case. Among them were 3 cases of giant cell tumor of bone, 1 case of osteoblastoma, 2 cases of osteosarcoma and 8 cases of metastatic tumor. According to the extent and area of the lesion, according to the classification criteria of Tomita, 1 case was type II, 5 cases was type III, 3 cases was type IV and 5 cases was type V. Preoperative spinal cord function Frankel grading, B grade in 3 cases, C grade in 4 cases, D grade in 5 cases, E grade in 2 cases. Results The incisions were all healed by first intention without any complications such as vascular or nerve injury. Fourteen patients were followed up for 11-64 months with an average of 32.5 months. Local pain symptoms were significantly relieved. X-ray examination was performed 6 to 8 months after operation. CT showed that Bridwell Ⅰ grade bone fusion was achieved. At 10 months after operation, the spinal cord function recovered from Frankel class B to D grade in 2 cases, C grade to D grade in 1 case, and the remaining 9 cases recovered to E grade. There was no obvious obstacle in walking function. Two patients died of brain metastases and liver metastases at 11 months and 15 months respectively. One patient with osteosarcoma died of lung metastasis at 16 months after operation. One patient had osteosarcoma at 8 months Local recurrence; I did not see tumor recurrence and metastasis. Patients with internal fixation were solid, no loose fracture, titanium mesh displacement collapse, no instability of the spine. Conclusions The posterior total spondylectomy combined with spine reconstruction for the treatment of thoracic and lumbar tumors has the advantages of relatively less trauma, complete rudiment resection, low local recurrence rate and adequate spinal cord decompression.