目的 :探讨胸腰椎肿瘤全脊椎切除手术的入路选择,初步评价不同手术入路的临床意义。方法 :2001年10月~2013年12月共收治74例胸腰椎肿瘤患者,男31例,女43例;年龄11~69岁,平均40.2岁。分别采用单纯后正中入路、后路联合前路或后路联合侧前方入路手术完成肿瘤的全脊椎切除。分析脊柱肿瘤WBB分期及肿瘤所在部位、是否首次手术与手术入路选择的关系。结果:选择后正中入路手术者25例,肿瘤位于B~D、3~9区15例,其中单节段12例,两节段3例;B~D、1~12区4例,其中单节段3例,两节段1例;肿瘤软组织肿块较小、位于A~D/E、3~9区4例,其中单节段3例,两节段1例;A~D/E、1~12区单节段2例。整块切除24例,大块经瘤切除1例。上胸椎2例,胸椎及胸腰段21例,中下腰椎2例。后路联合前方入路手术者30例,肿瘤侵袭A~D/E、累及1~12区20例,单节段11例,两节段及以上9例,其中复发肿瘤12例;累及3~9区8例,单节段5例、两节段及以上3例,其中上胸椎5例(复发肿瘤2例);累及B~D、3~9区的L4和L5肿瘤各1例。整块切除8例,大块经瘤切除22例。上胸椎7例,下腰椎(L4-L5)5例,胸椎或胸腰段18例。后路联合侧前方入路19例,肿瘤累及A~D/E、1~12区10例,单节段肿瘤9例,2节段1例;累及A~D/E、3~9区的单节段初次手术的胸腰段肿瘤5例,软组织肿块位于脊椎的侧方;累及B~D、1~12区的中下腰椎单节段肿瘤2例,胸腰段肿瘤2例。整块切除3例,大块经瘤切除16例。胸椎及胸腰段10例,中下腰椎9例。结论:胸、腰椎肿瘤全脊椎切除手术入路应根据肿瘤侵袭范围及所在脊椎部位进行选择。局限在脊椎骨内或椎旁肿块较小的单及两节段肿瘤选择单纯后正中入路;肿瘤突破脊椎致前方有较大肿块、复发肿瘤及侵袭椎旁的上胸椎肿瘤多选择联合前方入路;软组织侵袭位于脊椎侧方的肿瘤多选择后路联合侧前方入路。 Objective: To explore the choice of total spondylectomy for thoracolumbar tumors and to evaluate the clinical significance of different surgical approaches. Methods: From October 2001 to December 2013, 74 patients with thoracolumbar tumors were treated, including 31 males and 43 females, aged from 11 to 69 years (average 40.2 years). Pure posterior median approach, posterior combined posterior approach or posterior approach combined anterior approach were used to complete the total tumor resection. Analysis of the spine tumor WBB staging and tumor location, whether the first operation and the choice of surgical approach. Results: Twenty-five patients underwent midline approach were selected. The tumors were located in B ~ D and 3 ~ 9 districts, including 12 cases of single segment and 3 cases of two segments. There were 4 cases of B ~ D and 1 ~ There were 3 cases of single segment and 1 case of two segments. The soft tissue mass of tumor was smaller in 4 cases of A ~ D / E, 3 ~ 9, including 3 cases of single segment and 1 case of two segments. , 1 ~ 12 area single segment in 2 cases. 24 cases were resected, 1 case was resected by tumor. On the thoracic vertebra in 2 cases, thoracic and thoracolumbar in 21 cases, 2 cases of lower lumbar. There were 30 cases with posterior approach and 20 cases with invasion of A ~ D / E. There were 20 cases involving 1 ~ 12, 11 cases with single segment, 9 cases with two segments or more, including 12 recurrent tumors, 9 cases in 8 cases, single segment in 5 cases, two segments and more in 3 cases, of which 5 cases of upper thoracic spine (recurrent tumors in 2 cases); involving B ~ D, 3 ~ 9 area of ​​L4 and L5 tumors in 1 case. Eight cases were resected, 22 cases were resected by tumor. 7 cases of upper thoracic spine, 5 cases of lower lumbar spine (L4-L5), and 18 cases of thoracic spine or thoracolumbar spine. 19 cases were involved in the anterolateral anterolateral approach, including 10 cases of A ~ D / E, 1 ~ 12 cases of tumor, 9 cases of single segmental tumor and 1 case of 2 segments. A ~ D / E, 5 cases of thoracolumbar tumor with single segment primary operation and soft tissue mass located at the side of the spine. There were 2 cases of single segment tumors of middle and lower lumbar spine and 2 cases of thoracolumbar spine involving B ~ D and 1 ~ 12 regions. Three cases were resected, and 16 cases were resected by tumor. Thoracic and thoracolumbar in 10 cases, 9 cases of lower lumbar. Conclusion: Thoracic and lumbar spine total splenectomy approach should be based on tumor invasion and the location of the spine to choose. Confined to the vertebra or paravertebral mass smaller single and two segmental tumors after the selection of a simple median approach; tumor breakthrough the spine caused by a larger mass in front of the recurrence of tumor and invasion of paraspinal upper thoracic tumor multiple choice combined with the anterior approach ; Soft tissue invasion located in the lateral side of the tumor multiple choice posterior joint approach side of the road.