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目的探讨瘤椎全切与重建,治疗胸腰椎肿瘤伴神经功能障碍的手术适应证及临床疗效。方法1999年1月～2005年12月收治胸腰椎肿瘤伴神经功能障碍16例。男10例,女6例;年龄16～62岁,平均31.5岁。原发肿瘤10例,其中骨巨细胞瘤4例,软骨肉瘤3例,动脉瘤样骨囊肿术后复发2例,骨肉瘤1例;转移瘤6例。肿瘤侵犯T53例,T6、T6、7、T9、T11、L2、L4及L5各1例,T8、L1及L3各2例。Tomita外科分型:4型9例,5型6例,6型1例。Frankel神经功能分级:A级1例,B级4例,C级7例,D级4例。采用前后路联合手术,行瘤椎彻底切除,椎管减压,植骨重建。术后根据肿瘤病理类型行相应的辅助治疗。结果术后16例获随访10～63个月,平均27.5个月。患者疼痛均完全缓解,术后神经功能恢复至D级5例(其中1例术前为A级),E级11例。10例原发肿瘤中,1例骨肉瘤术后18个月双肺转移死亡,余9例均无瘤生存。6例转移瘤中,2例全身转移死亡,1例术后10个月肺部带瘤无症状生存,3例均无瘤生存。16例随访期内手术部位均无肿瘤复发。结论瘤椎全切与重建是治疗胸腰椎肿瘤伴神经功能障碍的一种安全有效的手术方法,可缓解疼痛,改善神经功能,减少肿瘤局部复发。手术适用于胸腰椎原发恶性肿瘤,有复发倾向的侵袭性肿瘤及Tomita外科分型为3～5型的胸腰椎单发转移瘤。
Objective To investigate the surgical indications and clinical effects of total excision and reconstruction of tumor vertebrae in the treatment of thoracolumbar tumors with neurological dysfunction. Methods From January 1999 to December 2005, 16 cases of thoracolumbar tumors with neurological dysfunction were treated. 10 males and 6 females; aged 16 to 62 years, mean 31.5 years old. 10 cases of primary tumors, including 4 cases of giant cell tumor of bone, 3 cases of chondrosarcoma, 2 cases of aneurysmal bone cyst recurrence, 1 case of osteosarcoma and 6 cases of metastatic tumor. T53, T6, T6, T7, T9, T11, L2, L4 and L5 were found in 1 case and 2 cases in T8, L1 and L3 respectively. Tomita surgical classification: 4 cases in 9 cases, 5 cases in 6 cases, 6 cases in 1 case. Frankel neurological grading: A grade in 1 case, B grade in 4 cases, C grade in 7 cases, D grade in 4 cases. Using anterior and posterior combined surgery, tumor vertebra complete resection, spinal decompression, bone graft reconstruction. According to the type of tumor pathology after the corresponding line of adjuvant therapy. Results 16 cases were followed up for 10 to 63 months with an average of 27.5 months. The patient’s pain was completely relieved. The postoperative neurological function recovered to grade D in 5 cases (one was preoperatively grade A) and E grade was in 11 cases. In 10 cases of primary tumor, one case of osteosarcoma died of lung metastasis at 18 months after operation, and the remaining 9 cases were tumor-free. Of the 6 metastases, 2 died of systemic metastases, 1 had symptoms of lung tumor asymptomatic in 10 months after operation, and 3 had no tumor-free survival. There were no tumor recurrences in all the 16 cases during the follow-up period. Conclusions Total tumor resection and reconstruction is a safe and effective surgical treatment of thoracolumbar tumors with neurological dysfunction. It can relieve pain, improve neurological function and reduce the local recurrence of tumors. Surgery for thoracolumbar primary malignant tumors, recurrent aggressive tumors and Tomita surgical classification of 3 to 5 type of thoracolumbar solitary metastasis.