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目的:总结后路一期整块全脊椎切除的手术经验、并发症和对神经功能的影响。方法:2006年8月至2007年9月对9例脊柱肿瘤患者进行后路一期整块全脊椎切除术,病理诊断包括4例骨巨细胞瘤,1例尤文肉瘤,1例孤立性浆细胞瘤,3例孤立性骨转移癌。8例患者肿瘤位于胸椎,1例位于腰椎。4例患者术前接受了病椎的选择性节段动脉栓塞。所有病例术前均根据Tomita脊柱肿瘤外科分期进行评估,2例患者为间室内,7例为间室外。对切除的肿瘤标本进行外科边界检查。采用Frankel分级对神经功能进行评价。结果:平均术中失血量5800ml,平均手术时间291min。2例患者获得广泛边界,其他为边缘性边界。1例术后血肿形成,1例脑脊液漏致胸腔积液,1例血肿形成合并脑脊液漏。随访14～36个月,平均25.8个月,在随访期内肿瘤无复发,2例转移癌及1例尤文肉瘤患者带瘤生存,1例转移癌死亡,4例无瘤生存。术后所有病例神经功能均获得改善或保持原有水平。结论:对具有适应证的胸腰椎肿瘤患者进行后路一期整块全脊椎切除手术可以获得满意的局部控制和功能恢复,但仍需要进一步随访并提高技术,减少合并症的发生。
OBJECTIVE: To summarize the surgical experience, complications and effects on the neurological function of posterior whole-block total spondylectomy. Methods: From August 2006 to September 2007, 9 patients with spinal tumors underwent anterior total lump resection. The pathological diagnosis included 4 cases of giant cell tumor of bone, 1 case of Ewing’s sarcoma and 1 case of isolated plasma cells Tumor, 3 cases of isolated bone metastases. Eight patients had their tumor located in the thoracic spine and 1 in the lumbar spine. Four patients underwent preoperative selective vertebral artery segmental artery embolization. All cases were preoperatively assessed according to Tomita’s spinal tumor surgical staging, 2 patients with interventricular and 7 patients with intercostal space. Surgical border examination of resected tumor specimens. Frankel grading was used to evaluate neurological function. Results: The average intraoperative blood loss 5800ml, the average operation time 291min. Two patients had extensive borders, others were marginalized. One case had postoperative hematoma formation, one case of cerebrospinal fluid leakage caused pleural effusion, and one case of hematoma with cerebrospinal fluid leakage. All patients were followed up for 14-36 months (average 25.8 months). No tumor recurrence was observed during the follow-up period. Two patients with metastatic carcinoma and one with Ewing’s sarcoma survived with tumor. One patient died of metastasis and four patients survived without disease. All cases of postoperative neurological function have been improved or maintain the original level. CONCLUSION: Satisfactory local control and functional recovery can be obtained in patients with indications of thoracic and lumbar tumors treated with one-stage whole-block total spondylectomy. However, further follow-up and techniques are needed to reduce the incidence of comorbidities.