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目的:探讨病变椎体切除脊柱稳定性重建治疗胸腰椎转移瘤可行性与临床价值。方法:1999年7月-2006年4月,采用后正中加后外侧“T”形切口行病变椎体切除、钛网+切除的肋骨或取自体髂骨填充植骨、椎弓根钉棒系统内固定治疗16例胸腰椎转移瘤患者,随访观察患者术后局部疼痛缓解、脊髓神经功能恢复及脊柱稳定性情况。结果:术后患者腰背痛及放射性疼痛基本缓解,均于术后早期开始肢体功能锻炼,术后2-3周离床活动。随访8个月-3年,患者神经系统压迫症状明显改善,3例C级患者2例恢复到D级,1例恢复到E级;D级5例均恢复到E级。影像学复查内固定物无松动、断钉、断棒现象,钛网无移位,椎体无塌陷。结论:经后正中加后外侧“T”形切口手术切除病变椎体并重建脊柱的三柱稳定性结构治疗胸腰椎转移瘤是可行的,可提高患者生存期内的生活质量。
Objective: To investigate the feasibility and clinical value of reconstructive treatment of thoracolumbar metastases by vertebral body excision and spinal stabilization. METHODS: From July 1999 to April 2006, posterior median plus posterior “T” shaped incision was used for vertebral body excision, titanium mesh + resected rib or autologous iliac bone graft and pedicle screw Sixteen patients with thoracolumbar metastasis were treated with rod system internal fixation. The patients were followed up for local pain relief, spinal nerve function recovery and spinal stability. Results: Postoperative patients with low back pain and radiological pain were basically relieved. All of them started limb functional exercise early after operation and got out of bed 2-3 weeks after operation. The follow-up of 8 months to 3 years showed that the symptoms of nervous system compression were significantly improved in 2 cases, 3 cases recovered to grade D in grade C, 1 case recovered to grade E. 5 cases in grade D recovered to grade E. Imaging review of the internal fixation without loosening, broken nail, broken rod phenomenon, no displacement of titanium mesh, vertebral body without collapse. Conclusion: It is feasible to treat the thoracolumbar metastases by transcatheter middle plus posterior lateral T incision and reconstruction of the three-column stability structure of the spine, which can improve the quality of life of patients during their life span.