摘要
目的探讨胸椎单脊椎肿瘤通过后路一期病椎切除、单纯植骨支撑融合或钛网支撑植骨融合、后路椎弓根钉系统内固定,达到切除病灶并同时重建脊柱稳定性的可行性。方法对18例胸椎单脊椎肿瘤患者行后路一期全脊椎切除、环脊髓减压,同时进行后路单纯植骨融合或椎间钛网支撑植骨,应用后路CD、TSRH或Scofix椎弓根钉系统内固定。男3例,女15例;年龄14～58岁,平均23岁。T41例,T51例,T62例,T84例,T93例,T104例,T112例,T121例。病理诊断:动脉瘤样骨囊肿4例,血管瘤2例,骨母细胞瘤2例,神经鞘瘤1例,骨巨细胞瘤5例,单发骨髓瘤1例,转移瘤3例。术前Frankel分级:A级6例,B级7例,C级3例,E级2例。结果术后随访3个月～2年,16例脊髓功能障碍者,12例完全恢复,4例部分恢复,所有患者局部疼痛均消失。1例术后出现一过性瘫痪加重,1例出现脊椎滑脱。术后平均植骨融合时间为3个月。1例骨巨细胞瘤患者复发;1例神经鞘瘤患者1年后局部出现包块,取活检报告为恶性肿瘤(未报组织学类型),4个月后死亡;1例肺癌转移患者术后6个月死亡;其余病例存活至今。结论对于胸段脊椎肿瘤行后路手术可一期实施单脊椎肿瘤彻底切除,并通过椎体间钛网支撑或植骨及后路椎弓根钉系统内固定重建脊柱的稳定性,效果满意。
Objective To discuss total vertebrectomy and spine stability and reconstruction by pos-terior ap proach for thoracic vertebra tumor and pedicle screw system fixation and intervertebral fusion.Methods Eighteen patients of 3males and15females of thoracic total vertebral tumor were operated in this group.The age of the group were from14to58years old,with the average of 23years.There were4aneurysmal bone cysts,2hemangiomas,2osteoblastomas,1neurilemomas,5giant cell tumor,1solitary myeloma and3metastatic thoracic vertebra tumors.The locations of the tumors was T 4 in1case,T 5 in1case,T 6 in2cases,T 8 in4cases,T 9 in3cases,T 10 in4cases,T 11 in2cases and T 12 in1case respectively.Pre-operative Frankel classification was grade A in6cases,B in7cases,C in3cases and E in2cases.Cir-cumferential decompression was performed with total spondylectomy through one-stage posterior ap proach.Anterior verte bral reconstruction was provided by autograft(ribs or ilium)bone or metallic cage;Posterior reconstruction was achieved by pedi cle screws system of CD or TSRH,Scofix fixation and auto graft fusion.Results The mean follow-up was8months,ranging from3months to24months.Twelve of 16cases with neu ro logical dysfunction were recovered completely,1case recovered from Frankel grade A to C,2cases from grade A to D,1case from grade B to D.The patient with neurilemmoma recurred and became ma lig nant after20months of operation and died4months later.One case of metastatic tumor of lung cancer sur vived6months after opera tion.One patient with giant cell tumor recurred.The other patients were still alive in the latest follow-up.There were no instruments breakage and spinal instability during the follow-up.Conclusion If the thoracic total vertebral tumor compress spinal cord se riously,the patients should be indi cat-ed for surgical treatment constructively.Total vertebrectomy followed by one-stage posterior approach re con-struction could relieve the com pression
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2003年第1期23-27,共5页
Chinese Journal of Orthopaedics
